Centers for Medicare & Medicaid Services is considering expanding the national coverage determination for allogeneic hematopoietic stem cell transplants using bone marrow or peripheral blood stem cell products for Medicare patients with myelodysplastic syndromes.
The request seeks full coverage of hematopoietic stem cell transplants (HSCT) for patients with myelodysplastic syndromes (MDS) and the removal of a coverage with evidence development requirement. The proposal applies to patients designated as high-risk or very high-risk. High-risk patients are most likely to develop leukemia. Other patients would be contacted by Medicare Administrative Contractors under the proposal.
MDS are a “group of disorders caused by blood cells that are poorly formed or don’t work properly,” said the Mayo Clinic. Age and genomics play a large role in a patient developing MDS, as more than 100 genes have been associated with the condition. Treatments often include blood transfusions or bone marrow transplants.
“MDS often results in fatality due, most often, to complications of cytopenia, or to progression to leukemia, but a large proportion of MDS patients will die of concurrent disease, and the comorbidities typical in an elderly population,” said CMS in its report Thursday.
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Exposure to the chemical benzeme or undergoing chemotherapy can increase your chances of getting the condition, and it can lead patients to develop leukemia. According to CMS and Medscape, HSCT treatments have been shown to improve blood counts and delay the onset of leukemia by infusing hematopoietic stem cells to boost blood cell production when an immune system is damaged.
The initial NCD was released by CMS in 2010. It said this version of treatment would only be covered if a patient enrolled in an approved clinical study. CMS’ proposal does not include treatment of acute myelogenous leukemia.
CMS received a request to reconsider the NCD from several associations and groups, including the American Society of Hematology. A 30-day public comment period begins now.