August 2007 Practice Update (part two)
Below is the latest information on the practice issues ASH has been following. We feel it is important to keep our membership well informed of ASH's practice-related activities, so we have decided to disseminate updates more widely throughout the ASH practice community. We would welcome any comments or feedback any of you may have. We strongly encourage you to share this message with your colleagues.
ESA Update: ASH Requests Reopening of National Coverage Decision
ASH has requested that CMS reopen its recent National Coverage Decision (NCD) concerning erythropoiesis-stimulating agents (ESAs) due to the limitations on patients undergoing ESA therapy for non-renal uses. Specifically, ASH has urged CMS to allow coverage for the continued use of ESA therapy where the patient is brought to a hemoglobin level between 10 and 12g/dL in order to appropriately manage care. Currently, the NCD stops coverage once the hemoglobin has reached 10 g/dL. Based on recent conversations, CMS appears to be willing to reconsider its NCD on ESAs once it receives additional information from the Society. For more information, please see ASH's news update on the NCD for coverage of ESAs.
ASH-ASCO Update on EPO Guidelines – Available Soon
A joint ASH-ASCO expert panel has updated the current guidelines on the use of EPO based on review of the most current literature. New topics include thromboembolic risk and use of Darbepoetin. The guideline update is undergoing joint submission processes for Blood and for the Journal of Clinical Oncology and is anticipated to be available online in late September.
ASH Practice Forum "Evidence, Safety, and Clinical Decision Making: The Case of ESAs" Scheduled for December 8 in Atlanta
The ASH Committee on Practice will sponsor a Practice Forum at the ASH annual meeting in Atlanta on Saturday, December 8, 2007 at 6:00 p.m. The Forum will feature presentations on the scientific evidence regarding potential adverse effects of ESAs, the newly updated ASH-ASCO practice guidelines, and an update of where legislation and regulations stand.
ASH Comments on CMS Proposed Physician Fee Schedule
ASH's comment letter to CMS concerning the proposed Physician Fee Schedule reflects the membership's concerns about adequate physician reimbursement. ASH's comments include several recommendations regarding physician payment, IVIG, new requirements concerning anemia quality indicator reporting, and off-label drug use.
Children's Health Bill Has Potential Impact on Physician Payments and the Physician Quality Reporting Initiative (PQRI)
Passing legislation that would reauthorize and expand the State Children's Health Insurance Program (SCHIP) is a high priority for the House and Senate in September, but its fate is uncertain. House and Senate bills are significantly different in terms of cost, funding, and expansion to Medicare issues. The House version is more expensive, replaces scheduled Medicare physician payment cuts of 15 percent over the next two years with two years of positive updates of 0.5 percent, and repeals the PQRI bonus program. To pay for increased spending, the House bill increases federal taxes on tobacco and eliminates overpayments to Medicare Advantage plans. The Senate version is more modest in cost and focuses strictly on reauthorization of SCHIP. The program is set to expire on September 30 and President Bush has promised to veto a broad expansion of the program.
Because preventing the scheduled cuts to physician payments must be addressed in legislation, ASH and other medical societies support the inclusion of the physician payment provision in the SCHIP reauthorization. If this provision is stripped out of a conference bill, ASH will continue to fight for separate legislation. All physicians are urged to contact Congress to support a physician payment fix. Please visit the ASH Advocacy Center today.
TAKE ACTION: ASH members are strongly encouraged to join ASH's online advocacy campaign to prevent the physician payment cuts. Through ASH's Advocacy Center, physicians can quickly and easily contact their Members of Congress to urge passage of legislation that would provide a positive physician update.
ASH SAS on Hematologic Malignancies and Cancer Associated Thrombosis – Register Now
The 2007 ASH State-of-the-Art Symposium (SAS) is a one-and-a-half-day focused conference taking place September 28-29 in Philadelphia, PA. This important meeting boasts a small attendee-to-speaker ratio allowing for plenty of interaction with your colleagues and the expert presenters. All attendees will receive 11.25 AMA PRA Category 1 Credits™ and complimentary copies of the SAS workbook and DVD.
This meeting will cover topics that will help you improve patient care. Session topics include management strategies for CML, thrombosis in cancer, marginal zone lymphoma and Hodgkin lymphoma, treatment strategies for follicular lymphoma and CLL, stem cell transplantation for lymphoma, and much more.
Register today and receive an extra $25 discount by entering the code AM2007 at checkout. The hotel deadline is September 6. Call the Hyatt Regency Philadelphia at Penn's Landing at 800-233-1234 or 215-928-1234 to reserve your room.
CMS Releases Guidance on Tamper-Resistant Prescription Pads
On August 17 CMS issued guidance on the implementation of recent legislation that restricts Medicaid pharmaceutical reimbursement to prescriptions executed on tamper-resistant pads. CMS has outlined three basic characteristics of tamper resistance, leaving it to each state to define specific features that meet those characteristics. By October 1, 2007, states must mandate that at least one of these features be met. By October 1, 2008, all three characteristics must be met to be eligible for reimbursement. CMS deems that tamper-resistant pads must:
- Prevent unauthorized copying of a completed or blank prescription form;
- Prevent the erasure or modification of information written on the prescription by the prescriber; and
- Prevent the use of counterfeit prescription forms.
These requirements apply in most clinical settings, though the guidance outlines exceptions, including for drugs provided in nursing facilities and intermediate care facilities for the mentally retarded. This guidance is applicable whether Medicaid is the primary or the secondary payor of the prescription being filled.
Blue Cross of California Introduces New Provider Access Framework for Intravenous Immunoglobulin (IVIG)
ASH has been closely monitoring issues related to the cost and delivery of IVIG, and it has been brought to our attention that Blue Cross of California (BCCA) has recently changed its provider framework for the product. BCCA will now contract exclusively with Crescent Health Care to provide IVIG in home care settings. Company officials have stated that they plan to initiate chart reviews for all IVIG patients with the goal of reducing product utilization statewide. ASH continues to follow this situation and will keep members informed of any new developments.
| 
