After much ado, CMS announced it would continue coverage for Avastin, the much debated breast cancer treatment, and start covering for Provenge (sipulecel-T), an immunotherapy treatment for prostate cancer, June 30 through an agency memo and a separate news conference. In each patient-driven decision, CMS concluded that Medicare beneficiaries deserve access to these drugs.
Medicare will continue to cover Avastin despite the Food and Drug Administration retracting its approval, according a New York Times article on the news conference. The embattled breast cancer drug’s effectiveness has been questioned and is currently facing Congressional appeal which won’t be decided until after the public comment period ends on July 28.
CMS also determined that beneficiaries will benefit from the nearly $100,000 per round Provenge treatment. CMS declared that trial evidence for the prostate cancer drug suggests it sufficiently improves health outcomes for patients with asymptomatic or minimally symptomatic metastatic castrate-resistant prostate cancer and should be a covered service to Medicare patients.
Although there was plenty of public support through official comments for Medicare to cover the vaccine after the March proposed rule, investigators reported underwhelming and, at times, conflicting results on the drug’s effectiveness, and some of the trials generated low or medium confidence for Provenge’s effectiveness.
Medicare did not have a National Coverage Determination (NCD) for Provenge and left coverage determination to the discretion of the Medicare Administrative Contractors (MACs). Coverage for Provenge’s off-label use, for patients with other forms of prostate cancer, is still left up to the carriers.