News | October 29, 2006

Prostate Cancer Coalition Calls for Medicare to Drop Policy of LCA

A coalition of groups representing prostate cancer patients issued a call this week for Medicare to drop its policy of least costly alternative (LCA) for prostate cancer patients.
The LCA policy encourages providers to give patients the treatment that costs the least where treatments are deemed by the Center for Medicaid and Medicare Services (CMS) as interchangeable.
At a recent Medicare Payment Advisory Commission (MedPAC) meeting, the commission considered changes to the average sales price (ASP) system because bundled discount arrangements by companies can have a warping effect on Medicare reimbursement rates for physicians, potentially driving them to make decisions that are not based on clinical factors. For these same reasons, the coalition seeks to have MedPAC also consider changes to the LCA policy. Both practices clearly alter market behavior.
"LCA policies for prostate cancer drugs are inappropriate because they substitute Medicare's determination that certain drugs are interchangeable for the physician's professional judgment that one drug may be more efficacious or have fewer side effects for a particular patient," said a joint letter to MedPAC from the coalition.

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