Medicare covers Avastin here, but not there

In another U.S. meets the U.K. story, a Colorado state representative is fighting the feds to get Roche/Genentech's Avastin [1] covered by Medicare [2]. Yes, Medicare. Apparently, the Center for Medicare and Medicaid Services doesn't cover Avastin treatment for ovarian cancer in Colorado, despite the fact that it's paid for in California and New York.

"How can I help you effect this change in policy, quickly, before one more Colorado woman died from ovarian cancer by dint of being on the wrong side of a state border?" she wrote (as quoted by the Denver Post). Shades of the U.K.'s National Health Service! And you thought that kind of rationing only happened overseas.

Apparently, what's happened in Colorado is that the state's Medicare contractor has chosen not to pay for the drug. And that's perfectly OK under federal rules, because a.) the FDA hasn't approved Avastin for ovarian cancer, though it can be used off-label for that purpose, and b.) the Centers for Medicare hasn't ruled one way or another on Avastin in ovarian cancer. That gives individual regions the power to make their own decisions about off-label coverage.

- see the Denver Post story [3]
- check out the background [4], also in the Denver Post

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