It's an anemia-drug pile-on: Aetna has tightened up its reimbursement rules for Aranesp, Epogen, and Procrit--and analysts believe it will be the first of many private insurers to make the move. Medicare restricted dosages in July after evidence surfaced that higher dosages could cause severe heart problems.
While Aetna's new policy isn't as restrictive as Medicare's, it is limiting. It requires patients to have low hemoglobin before getting the drug. And the insurer says it doesn't plan to back off from the change even if members balk. Earlier this summer, Blue Shield of California tried to restrict the drugs' dosages but changed its mind soon after when members complained.
If more private insurers follow Medicare's example, Amgen and Johnson & Johnson could suffer badly. Amgen's Aranesp sales fell 20 percent in the third quarter following Medicare's limitation.
- check out the report from the Los Angeles Times
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