CMS to set standard Medicare reimbursement rate for some cancer drugs

December 10, 2007

New Medicare rule cuts reimbursement for class of non-Hodgkins lymphoma treatments

A standard Medicare reimbursement rate for a class of cancer drugs called radioimmunotherapies will be set by CMS beginning Jan. 1, 2008 despite the objections of patient advocates and makers of the treatments. The groups objecting to the new rule say the standard reimbursement rate for these drugs, which only need to be administered once and are used to treat non-Hodgkins lymphoma in people who have not responded well to other treatments, sharply reduces payment and might make the drugs inaccessible to patients. The drugs include Bexxar (GSK) and Zevalin (Biogen Idec). Under the new rule, CMS will reimburse Medicare physicians about $16,000 for each treatment administered. GSK and Biogen say the treatments cost about $30,000 each. CMS officials stated that they based the new rate on actual prices hospitals have paid for the drugs. Most other drugs administered by injection at physician offices and hospital outpatient clinics are reimbursed based on the average price of the drugs plus a 6% fee to cover handling costs. To see more Daily News articles, click here. To go to the Drug Topics homepage, click here.

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