House votes to give public a say in local Medicare coverage decisions

The House of Representatives voted unanimously Wednesday in favor of legislation that would require Medicare contractors to consider public input and consult an expert panel before finalizing local coverage determinations, which govern whether Medicare will cover a drug or service within a certain geographical region.

Decisions on Medicare coverage of a drug can take one of two paths. In certain cases, CMS may develop a National Coverage Determination, which would apply to all beneficiaries regardless of region. In the absence of an NCD, Medicare coverage of a drug is left to the discretion of local contracted intermediaries or carriers, which make region-specific determinations based on patient demographics...