Medicare Rethinking Its Policy on Self-Injectables

Medicare has scheduled a national meeting on self-injectable drugs for May 18 in Baltimore. The meeting comes after Medicare issued a program memorandum on March 17 saying that it will reimburse for chemotherapy drugs that patients are too sick to self-administer.

Congress forced HCFA’s hand by passing an amendment to that effect in 1999. Since August 1997, Medicare insurance carriers had made reimbursement decisions based on whether a drug could theoretically be self- administered. If so, then there was no reimbursement, even if a patient was so sick that he or she had to have an oncologist administer the drug in the office. Says Michael Bilirakis (R-FL), chairman of the House commerce subcommittee on health and environment, “After the new 1997 policy took effect, Blue Cross and Blue Shield of Florida attempted to deny coverage for Neupogen based on the fact that it could be self-administered—even though it is usually administered by a physician in conjunction with chemotherapy.” The congressional amendment applies only to fiscal year 2000, which began October 1, 1999 and ends September 30, 2000. So cancer advocates think a permanent “fix” is needed to prevent Medicare from cancelling its March 17 program memorandum on September 30.