Medicare contractor in Southeast retires least costly alternative LCD

May 13, 2010

Pinnacle Business Solutions Inc. Medicare Services has announced the retirement of least costly alternative (LCA) local coverage determinations (LCDs) for certain prostate cancer drugs, a move AUA called a "welcome development."

Pinnacle Business Solutions Inc. Medicare Services has announced the retirement of least costly alternative (LCA) local coverage determinations (LCDs) for certain prostate cancer drugs, a move AUA called a "welcome development."

Pinnacle is the Medicare Administrative Contractor (MAC) for Louisiana, Arkansas, and Mississippi.

In an April 22 statement on its Web site, Pinnacle said, "Based on instructions from CMS, local coverage determinations in which least costly alternative provisions exist are to be changed."

Pinnacle said the following LCDs will be retired, not finalized, or removed from comment period effective April 19, 2010:

  • AC-07-004 LHRH analogs, agonists, and antagonists for treatment of malignant neoplasm of the prostate (L26245)
  • ARA-07-004 LHRH analogs, agonists, and antagonists for treatment of malignant neoplasm of the prostate (DL30746)
  • PBSI-A-10-045 LHRH analogs, agonists, and antagonists for treatment of malignant neoplasm of the prostate (DL31046).

AUA said in a statement that staff members "are doing research to determine if this retirement of LCA LCDs is going to be extended to other MACs around the country. This is a welcome development, which may have resulted from the legal victory in the Washington, DC, Court of Appeals over an LCA policy on another drug."