Welthy Posted August 29, 2007 Share Posted August 29, 2007 This isn't official news, but have learned through our Oncologist, that brand new rules and regs have occurred for Medicare patients taking Procrit in the past 2-3 weeks. They now cannot start Procrit until the hemoglobin drops below 10.0. (It used to be 12.0) If the patient doesn't respond with at least a one point bump at 40,000 dosage in 4 weeks it gets a little blurry as to what Medicare will cover. The Procrit Rep was at our oncologist while we were there on Monday prepping the staff about the new rules. Medicare used to allow a larger dosage (60,000) after 4 weeks with low response. They may allow coverage for a bump to 50,000 dosage, but we left the office before confirming that information. The nurses were under the impression that without seeing significant improvement, Medicare will yank coverage for ANY procrit for a given patient. Apparently this is Medicare's second knee-jerk reaction to the possible side effects of trying to over-enhance the hemoglobin counts that was reported earlier this year. Our nurses feel this will lead to far more blood transfusions happening as Medicare nukes the blood enhancer options. (I don't know how this applies to Aranesp, but it may also impact the use of that enhancer too.) No Medicare coverage adjustments have been made to the WBC enhancers. Just a perspective from our nurses/oncologist that I thought Medicare folks should know. For us, it comes at a bad time. Until very recently Tony's counts were always great, but suddenly his hemoglobin has taken a nose-dive. Timing is everything --- geez. I'll try to get the full lowdown next visit. Welthy Quote Link to comment Share on other sites More sharing options...
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