U.S. lawmakers examine Medicare anemia drug payments
WASHINGTON, June 26 (Reuters) - Medicare needs to change the way it pays for anemia drugs to discourage excessive use in kidney dialysis patients, a key U.S. lawmaker said on Tuesday.
The federal health insurance program for the elderly and disabled spends about $2 billion annually on Amgen Inc.'s (AMGN.O) Epogen, part of a class of anti-anemia drugs called erythropoiesis-stimulating agents (ESAs).
Critics say current payment methods have promoted aggressive treatment. Concern grew when recent studies showed high doses could lead to heart complications or death.
"Medicare can be a better purchaser of care for dialysis beneficiaries, and can do so in a way that ensures more efficient use of ESAs and better health outcomes for beneficiaries," said Rep. Pete Stark, a California Democrat who chairs the House of Representatives Ways and Means health subcommittee.
Some experts advocate "bundling" payments for the drugs with the payments for kidney dialysis services, which they say would encourage doctors to use only as much drug as needed.
"Bundled payments would encourage more efficient use of ESAs," Stark said at a subcommittee hearing.
Patients with kidney failure need regular dialysis to help clear their blood of waste. Anemia, a shortage of red blood cells, is a common side effect of the disease and can cause fatigue and headaches.
Some lawmakers worried new payment policies could lead to some patients getting too little of the anemia-fighting drugs.
"Any type of bundled payment must provide a proper adjustment to account for sicker patients," said Rep. Dave Camp, a Michigan Republican.
Stark said lawmakers "are not recommending a one-size-fits-all system" and would advocate flexibility for doctors to treat patients properly.
Leslie Norwalk, head of the Centers for Medicare & Medicaid Services, pledged to provide Congress a report within weeks explaining how Medicare could bundle payments. Stark said the report had been due in October 2005.
Amgen, in written testimony submitted to lawmakers, said most Epogen use in dialysis "has been and continues to be appropriate." Doctors have become more conservative in prescribing Epogen for dialysis patients, the company said.
"Based on the best available scientific evidence and utilization data, there does not appear to be a compelling policy or clinical rationale to immediately make fundamental, untested changes to the dialysis payment system," said Dr. Joshua Ofman, an Amgen vice president.
Amgen sells a longer-lasting version of Epogen called Aranesp, although experts say the latter is generally not marketed to dialysis clinics.
Johnson and Johnson's (JNJ.N) Procrit also treats anemia in chronic kidney disease patients but is not approved for those on dialysis.
