Blue Shield of Ca. curbs anti-anemia drug limits

By Lisa Baertlein

LOS ANGELES (Reuters) - Blue Shield of California said on Wednesday it reversed parts of a recent policy change that limited when the insurer would pay for anemia drugs sold by Amgen Inc and Johnson & Johnson following protests from doctors.

Privately held Blue Shield, which has more than 3 million members in California, earlier this month imposed new coverage guidelines that, among other things, required doctors to wait until an anemic cancer patient's hemoglobin level fell to levels closer to the cutoff for needing a blood transfusion.

The drugs at issue include Amgen's Aranesp and Epogen, and J&J's Procrit, which belong to a class known as erythropoietin-stimulating agents (ESAs) that are used to boost levels of oxygen-carrying red blood cells.

Aranesp and Epogen, Amgen's biggest revenue drivers, were the top-selling biotech drugs in 2006 with sales of roughly $7.2 billion, according to IMS Health. Procrit was 2006's fifth-biggest biotech drug with sales of $2.9 billion.

ESAs have been under intense scrutiny over concerns about their safety and potential overuse.

Blue Shield spokesman David Seldin said that as of its July 20 update, the insurer would cover anemia drugs when a patient's hemoglobin levels hit 10 grams per deciliter of blood or less.

On July 2, its guidelines had required hemoglobin levels to fall to 9 grams per deciliter of blood or less, except in the case of patients with heart conditions whose coverage would kick in when hemoglobin levels hit 10 gm/dl or less.

Blue Shield had previously covered the drug for patients with hemoglobin levels of 11 or less.