• E-mail
• Print
• RSS

Medicare to cover aprepitant for chemotherapy nausea

Pharmacy Regulation Resource, January 12, 2005

The Centers for Medicare & Medicaid Services (CMS) announced January 6 that it intends to cover the oral drug aprepitant for the treatment of chemotherapy-induced nausea and vomiting (CINV) in patients who do not respond to the standard drugs used to treat these symptoms.

The symptoms often occur with some anti-cancer chemotherapeutic drugs.

Because evidence in clinical trials has shown that aprepitant is more effective for the treatment of CINV when used in combination with other
anti-vomiting drugs, aprepitant would be covered by Medicare only when used in combination with two standard anti-emetics drugs, a 5-HT3 antagonist and dexamethasone, according to a CMS press release.

"We are continuing to work to keep our coverage up-to-date with advances in medical technology that improve beneficiary health," CMS Administrator Mark McClellan, MD, PhD, said in a prepared statement. "This new drug coverage will provide important help for some patients undergoing chemotherapy who don't respond to the usual nausea treatments."

Medicare typically does not cover drugs that a patient self-administers, such as oral drugs. However, the law provides coverage for oral drugs used to treat CINV if the oral anti-vomiting drug functions as a replacement for the intravenous drugs that would have otherwise been administered. In this case, the combination of the three drugs will replace the intravenous drugs that would otherwise be necessary.

Aprepitant may likely have other uses beyond those consistent with the part B proposed benefit category determination, according to CMS. Beginning January 1, 2006, aprepitant for these other uses will be covered under Medicare Part D, the new prescription drug benefit created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

As a result, aprepitant would be covered under part B for the indications specified in the proposed National Coverage Decision (NCD) and under part D for others. Based on the NCD guidelines, it will then be up to the provider to determine whether aprepitant is prescribed under part B or part D. Part D indications may likely represent the largest proportion of the use of aprepitant by Medicare beneficiaries.

CMS seeks public comments on the proposed national coverage determination available for review online. Click on the link "Aprepitant for Chemotherapy-Induced Emesis" at www.cms.hhs.gov/mcd/index_list.asp?list_type=nca.

• E-mail to a Colleague
• Print
• RSS
• Archive