October 18, 2007

A dispute is raging in Congress, and in the media, over a recent CMS decision that limits reimbursements for drugs that can be used to boost oxygen-carrying red blood cells in cancer patients.

Several members of Congress are floating legislation that would overturn CMS' decision, and some consumer groups, reports The Hill, are telling them - politely - to butt out.

Led by the Center for Science in the Public Interest (CSPI) and the Consumers Union, the groups on Tuesday weighed in on one of the battles being waged between lawmakers, the Centers for Medicare and Medicaid Services (CMS) and powerful interest groups. At stake are the medicines — called erythropoiesis-stimulating agents but more commonly referred to as EPO or ESAs — used to treat anemia in chemotherapy and kidney dialysis patients.

Last month, Reps. Anna Eshoo (D-Calif.) and Mike Rogers (R-Mich.) introduced legislation to overturn a CMS decision to restrict Medicare coverage of the anemia drugs. CMS's "national coverage determination" in July followed a March decision by the Food and Drug Administration (FDA) to require on the drugs' labels a strong "black box" warning about serious or fatal side effects when the drug is used at high levels.

Now, specifics aside, the irony here is thick enough to cut with a knife. Congress interferes with the practice of medicine all the time, and plenty of lobbying groups encourage them to do it. As government funding for health care grows ever larger, the temptation to micromanage health care funding in favor of one group or treatment (think generic v. branded drugs, or Congress' perennial habit of yo-yoing physician's fees in Medicare) will only increase.

Regina Herzlinger discusses this phenonomenon at length in her book Who Killed Health Care?, and it is as inevitable as the Defense Department writing endless pages of specs for defense contractors.

In the case of health care, however, the interests of patients and payers (and policymakers) don't line up nearly as well as those of soldiers and defense contractors. What is the "right" amount of EPO?

That depends on the patient, her condition, and her doctor's judgment. And no consumer group, Congressional committee, or CMS rule (no matter how well intentioned) can possibly come up a single rule that covers all particular cases.

And EPO is only the tip of the iceberg.

Posted by Paul Howard at October 18, 2007 12:43 PM

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