October 2007 Practice Update

Physicians Await Congressional Action on Scheduled Medicare Payment Cuts
Absent Congressional action, physicians face Medicare payment cuts of 9.9 percent beginning in January 2008. Although a provision to replace the cut with a 0.5 percent payment increase was originally included in the children's health bill (H.R. 976), it was stripped from the legislation. ASH continues to work with Congress to identify a legislative vehicle that can be enacted by the end of this year to prevent the cuts. All physicians are urged to contact Congress to support a physician payment fix. Please visit the ASH Advocacy Center today.

ESA Update: House Members Introduce Bill to Require CMS to Reverse Medicare Coverage Decision for Anemia Medications
Reps. Anna Eshoo (D-Calif.) and Mike Rogers (R-Mich.) have introduced a bill (H.J. Res. 54) that would reverse a CMS decision to limit Medicare coverage of ESA therapy for cancer patients.

The legislation would require CMS to reverse the decision. The House has not scheduled a vote on the bill, which requires approval from Congress and President Bush. Policy analysts believe the legislation will likely fail, but still puts increased pressure on CMS to revisit its policy. Earlier this month the Senate passed a non-binding resolution in support of CMS reopening its coverage decision.

In a letter sent to CMS on August 8, ASH recommended that Medicare reopen the decision to allow maintenance of ESA therapy when the patient's hemoglobin is above 10g/dL but below 12g/dL, consistent with the Society's practice guidelines. Recently CMS sent a letter to ASH and other interested groups indicating that it would not revise the decision without additional evidence. ASH continues to work with CMS and Congress on this important issue and will keep members apprised of new developments.

ESA Update: ASH Weighs in on Local Level
The local Medicare carriers have been sent complex and seemingly contradictory messages from CMS on ESA treatment of anemia for patients with MDS. The initial CMS policy directed the carriers not to cover ESA treatment for MDS patients while the revised policy does not address coverage for MDS. As this issue is reserved for carrier discretion, some local carriers are beginning to craft restrictive policies regarding MDS. ASH is monitoring the development of local coverage decisions concerning ESA coverage for MDS patients and is providing local carriers with information and recommendations. Contact us with any questions or concerns you have in your area.

Congress Delays Tamper-Proof Rx Pad Regulation
Physicians and pharmacies will have an extra six months to implement a Medicaid requirement that prescriptions be written on tamper-resistant paper for pharmacies to receive reimbursement. New legislation (H.R. 3647) passed at the end of September resolves the problem that the tamper-proof mandate original implementation date of October 1, 2007, did not provide enough time for states to in have more time to acquire the pads. The extension means that pharmacies will be able to avoid having to forgo reimbursement or turn patients away.

President Bush Vetoes SCHIP Legislation
On Wednesday, October 3, President Bush vetoed a children's health bill (H.R. 976) passed by Congress in September that would have expanded the scope of the State Children's Health Insurance Program. The bill passed with a veto-proof majority in the Senate, but not in the House. ASH will keep its membership abreast of any new developments on this issue.

CMS Releases Average Sales Price Payment Amounts
CMS has made available the Medicare Part B Drug and Biological Average Sales Price (ASP) Payment Amounts for October 1, 2007 to December 31, 2007 on the CMS Web site. The files are located in the "Downloads" section of this web page.

Save the Date – or Dates – for Highlights of ASH^®
This year Highlights of ASH is taking place in Seattle, WA on February 1-2, 2008, and in Austin, TX on February 8-9, 2008.