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CQ Healthbeat – CMS Open to New Approaches on Cancer Drug Coverage

CQ Healthbeat – CMS Open to New Approaches on Cancer Drug Coverage

Medicare officials are evaluating new approaches to finding the most effective cures for cancer.

Researchers developing more targeted therapies are anxious to see whether cancer drugs approved for use in one part of the body might be useful if a similar form of the disease appears elsewhere.

Medicare data indicates that on average about 1 million people enrolled in the program are diagnosed with cancer each year, said Jeffrey Roche, a Centers for Medicare and Medicaid Services medical officer.

“That’s a pretty big burden of disease, and we’re conscious that new approaches to evidence development … may help us,” he said at a recent conference held by the Friends of Cancer Research and Brookings Institution.

Palmetto GBA, a Medicare contractor, and the American Society of Clinical Oncology are seeking to more broadly assess the potential uses of cancer drugs.

Palmetto intends to use molecular testing to assess how well people with certain kinds of cancer fare on treatments not specifically approved for their disease, a practice known as off-label prescribing.

The American Society of Clinical Oncology intends to create a registry to follow patients whose cancer has progressed after receiving standard treatments and who have signs of a genetic marker in tumors that might be controlled by off-label use of another oncology drug.

There’s been a “tremendous revolution” in cancer treatment, said Richard Pazdur, the head of the Food and Drug Administration’s oncology medicines unit. There has been progress away from the use of medicines that broadly kill fast-growing cells, a class that covered many forms of cancer among with several types of healthy cells as well.

“This requires some changes in our thinking,” Pazdur said at the conference. “We are going to have smaller numbers of patients to base decisions on. That’s a fact.”

At CMS, one response to these challenges has been use the coverage-with-evidence approach. The agency used this for a kind of test, fluorodeoxyglucose positron emission tomography, for diagnosing solid tumors. CMS established a registry in 2005 to track how data on use of this test in Medicare patients. Based in part on the data gathered, Medicare expanded coverage in 2013.