According to Medicare, the U.S. healthcare program will continue paying for Roche Holding’s drug bevacizumab (Avastin) for breast cancer, regardless of what health regulators decide about the medicine’s future.
The statement from Medicare will likely reassure patients using the drug who are concerned that they might lose insurance coverage should the U.S. FDA revoke approval for its use in breast cancer. FDA Commissioner Margaret Hamburg is expected to make a final decision later this year.
Doctors would still be able to prescribe Avastin if the FDA revokes approval. “The FDA decision, when it comes, does not affect CMS,” according to Don McLeod, a spokesman for the Centers for Medicare and Medicaid (CMS). “The drug will still be on the market, doctors will still be prescribing it, and we will continue to pay for it,” he said, adding that CMS often pays for off-label uses of drugs. CMS often takes its cue from groups like the National Comprehensive Cancer Network (NCCN), which represents leading cancer treatment centers. Insurance companies, in turn, generally take into account CMS decisions to help determine their own coverage. WellPoint Inc recently announced that it would also not drop support for patients already taking Avastin and is unlikely to disrupt coverage for new patients. Earlier this year, the market research firm Reimbursement Intelligence surveyed 55 third-party payers and found that 45 covered bevacizumab for treatment of breast cancer.
Patient groups say Avastin has saved many lives even if this effect does not show up in broader sets of data. They have pleaded with the FDA to keep the breast cancer label. Through its patient access program, Roche/Genentech said it plans to continue to provide Avastin for free to women without insurance or whose insurance drops Avastin coverage.