CMS: No national coverage policy needed

Tuesday, July 31, 2007

WASHINGTON - CMS ditched plans to create a national coverage policy for levalbuterol June 20, saying there was no evidence to support it.
On Dec. 20, the agency had initiated a review of the use of levalbuterol in the treatment of COPD (See HME News, February 2007). The move had delayed possible cuts to nebulizer medications for the first half of this year.
The announcement coincided with the release of third quarter average sales price figures, the first in which brand-name Xopenex and albuterol will be paid at the same rate, $1.31 per unit dose.
Joe Lewarski, vice president of clinical and government affairs for Inogen, described it as a "non-decision."
"In reading the research they reviewed, it seemed clear in the data that they cited that it is the standard of care in the management of patients with COPD," he said.
Still, Lewarski said, keeping coverage determinations local probably allows more flexibility. Others see it as another example of CMS's lack of consistency.
"I wish they'd put all their cards on the table," said Kelly Riley, director of The MED Group's National Respiratory Network. "I think we all do business better when we know what the rules are."
CMS received a total of 82 comments during the initial comment period for the NCD. Fifty-six were against restricting Part B coverage, while eight favored some guidelines. The other 18 pertained to issues outside the NCD.