This particular statement really bothers me, is CMS now going to take on the role of “doctor here?  “The Bush administration argued that Medicare officials had the right to decide whether the expense incurred for a given item, not just the item itself, was “reasonable and necessary.” image

How can CMS determine if the product or drug is necessary?  Are they examining and treating patients, don’t think so, they are only practicing risk management.  

All this would stand to do is further prevent access to drugs and therapies. Why does CMS not work together with Congress on negotiating better contracts with the pharmaceutical companies as an alternative or do we not work at teams anymore.  Physicians compensation was also going to be cut until so many threatened to not take Medicare patients. 

The outlook for Pharma growth in the US coming up is flat with perhaps the exception of cancer and related drugs, and drug companies are already looking to countries like Brazil and China for additional sales from those who can afford it in those countries.  There has already been a big move and it is still occurring to move to generic drugs when they are effective, so why we have to absolutely continue the course of just least cost routing without any concern for what is clinically effective?  BD

WASHINGTON — A federal court has blocked the Bush administration’s effort to save money on Medicare by paying for only the least expensive treatments for particular conditions.  Congress sets Medicare payment rates and never intended to give officials broad discretion to alter them, the court said in an important test case on Oct. 16.

The case, just now being scrutinized by Medicare officials and consumer advocates, involved drugs used to treat chronic obstructive pulmonary disease.

Judge Henry H. Kennedy Jr. of Federal District Court here said the policy of paying for only “the least costly alternative” was not permitted under the Medicare law.

Health care providers, manufacturers and some patients’ advocates have resisted these efforts, saying that coverage decisions should be made based on clinical effectiveness and not cost.

Scott T. Williams, vice president of Men’s Health Network, an education and advocacy group, welcomed the court decision. Mr. Williams said the decision would be “a springboard to help ensure that prostate-cancer patients have access to drugs like Lupron and Zoladex, rather than being forced to use the least costly alternative products.”


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