BioCentury
ARTICLE | Politics & Policy

Aetna issues new ESA policy

October 20, 2007 1:45 AM UTC

Private insurer Aetna issued a new policy regarding its coverage of erythropoiesis-stimulating agents (ESAs) that is less restrictive than that of the Centers for Medicare & Medicaid Services (CMS). For example, Aetna would cover ESA initiation to treat chemotherapy-induced anemia in patients with hemoglobin (Hb) levels <12 g/dL who also showed symptoms of anemia, limited cardiopulmonary reserve or unstable angina. Aetna also would allow for weight-based dosing to be increased by 100% for hypo- or non-responders in the indication. CMS's final National Coverage Determination (NCD) requires an Hb level <10 g/dL for ESA initiation to treat chemotherapy-induced anemia and allows a one-time dose escalation of only 25% in the fifth week of ESA therapy within any one course of chemotherapy (See BioCentury, Aug. 06, 2007).

Aetna said it revised the policy based on dosing recommendations from the American Society of Clinical Oncology. Amgen (AMGN) said "the Aetna policy is much better aligned with the clinical guidelines from the leading oncology medical societies than that CMS policy." ESAs marketed for chemotherapy-induced anemia include Aranesp darbepoetin alfa from Amgen (AMGN) and Procrit epoetin alfa from Johnson & Johnson (JNJ). ...