Coalition urges CMS to drop LCA policy for prostate cancer drugs

November 16, 2006

A coalition of prostate cancer advocacy groups has issued a call for Medicare to drop its least costly alternative (LCA) policy of for prostate cancer patients.

A coalition of prostate cancer advocacy groups has issued a call for Medicare to drop its least costly alternative (LCA) policy for prostate cancer patients. The policy encourages providers to give patients the treatment that costs the least where treatments are deemed interchangeable by the Centers for Medicare & Medicaid Services.

Recently, the Medicare Payment Advisory Commission (MedPAC) considered changes to the average sales price system because bundled discount arrangements by companies can warp Medicare reimbursement rates for physicians, potentially driving them to make decisions that are not based on clinical factors, according to the coalition, which includes the Men’s Health Network, the National Prostate Cancer Coalition, the Prostate Health Education Network, and Us TOO. For the same reason, the coalition wants MedPAC to consider changing the least costly alternative policy. Both practices alter market behavior, the coalition said.

“LCA policies for prostate cancer drugs are inappropriate because they substitute Medicare’s determination that certain drugs are interchangeable for the physician’s professional judgment that one drug may be more efficacious or have fewer side effects for a particular patient,” the coalition wrote in a letter to MedPAC.

“All things being equal, cheaper is, of course, always perceived as better,” said Scott Williams of the Men’s Health Network. “But all things are not equal. This is treatment for cancer, and the impact of the least costly alternative means that the treatment you get is not based on what is best for you, but what is cheapest. That simply isn’t fair to the patient who is fighting for his life. It is past time for CMS to review and remove policies that threaten, rather than support patients.”