Medicare contractor won't stop paying for Avastin

Is it a Medicare contractor's prerogative to change its mind? Apparently so: Palmetto GBA, which determined last week that it would stop paying for new Avastin prescriptions for breast cancer treatment, has backed off. The company now says it will continue paying for the drug while its manufacturer, Roche's Genentech, appeals an FDA decision to rescind its breast cancer indication.

The FDA decided last month that Avastin wasn't effective enough in breast cancer patients to outweigh the risk of serious side effects, revoking the drug's indication for that use and touching off a firestorm of protest from politicians and some patient groups. Genentech immediately said it would ask FDA to reconsider, and as the New York Times reported last week, FDA officials had said Medicare would hold off on reimbursement changes until after that appeal was heard.

But the Times broke the news that Palmetto had issued new coverage rules: The contractor would stop paying for Avastin as a breast cancer drug beginning January 29; the rules would apply to new scrips for new patients in six states. As the newspaper now reports, publicity about Palmetto's new policy raised eyebrows at Medicare HQ, and the contractor reversed course.

Palmetto "has suspended consideration of changes in its reimbursement policy for Avastin as a treatment for breast cancer," spokesman Billy Quarles told the Times. "Current reimbursement policies will remain in place until final adjudication of the manufacturer's administrative appeal."

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