CMS recognizes NCCN compendium in coverage decisions on chemo drugs

July 14, 2008

The NCCN compendium will be used as a source for making chemo drug benefit decisions under Part B.

CMS Acting Administrator Kerry Weems said that CMS uses the NCCN compendium to ensure that Medicare contractors and their physicians have the most up-to-date drug information and the best available treatment options.

In addition to NCCN, CMS is also considering three other compendia: Gold Standard's Clinical Pharmacology, Drug Points and DrugDex from Thomson Micromedex. Decisions on these compendia are expected by early July.

"NCCN has made a commitment that they are going to keep their guidelines up-to-date," said Fred Pane, R.Ph., senior director of pharmacy affairs at Premier Inc.

"We were pretty confident that we were going to get recognized by CMS," said William McGivney, Ph.D., CEO of NCCN. McGivney told Drug Topics that NCCN met all the requirements and had the highest score [as given by the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) in March 2006] of any competing compendia, including two that are already recognized by CMS.

The Social Security Act recognizes the following compendia: AMA-DE, United States Pharmacopoeia-Drug Information (USP-DI) or its successor publication, and American Hospital Formulary Service-Drug Information (AHFS-DI) published by the American Society of Health-System Pharmacists as authoritative sources for use in determining a "medically accepted indication" of drugs and biologicals used off-label in a chemotherapeutic regimen. AHFS-DI is the only originally named compendium currently in publication.

To ensure that contractors continue to have access to up-to-date drug compendia to make coverage decisions, CMS created a process to change its compendia reference list. This process included the recommendations from CMS' Medicare Evidence Development & Coverage Advisory Committee, which advised CMS on the factors the agency should consider when updating the list of compendia. The process also includes a 30-day public comment period.

Not everyone in the pharmacy community is pleased with some of the other compendia that CMS is considering. In a letter to CMS, ASHP cited media reports questioning DrugDex's connections with the pharmaceutical industry. Thomson has denied ASHP's charges and stated that it is committed to providing unbiased, evidence-based information and that it adheres to a conflict-of-interest policy that is consistent with industry standards.

The selection of its compendium by CMS is the second coup for NCCN this year. In January, United Healthcare (UHC) became the first major payor to base its benefit coverage for chemo drugs used in outpatient settings on the NCCN compendium.

Now that both UHC and CMS base their benefit coverage on NCCN's compendium, will this set the stage for other payers to follow in their footsteps? McGivney remarked, "We believe that other private payers will follow."

THE AUTHOR is a writer based in New Jersey.