Medicare Questions Coverage of Anemia Drug Epogen

In what could be a serious blow to drug maker Amgen, a Congressional panel recommended changing the way Medicare pays for Amgen’s Epogen, a wildly popular–some say overused–drug used in the treatment of anemic kidney patients. The House Ways and Means Committee held a two-hour hearing earlier this week to discuss the issue. Anemia drugs are currently Medicare’s largest drug expenditure and account for approximately $6 billion in revenue and $2 billion in profit for Amgen.

At issue is the fact that Medicare has separate reimbursement methods for dialysis treatments and drug prescriptions. Dialysis centers can currently charge a 6 percent premium on <"https://www.yourlawyer.com/topics/overview/epogen">Epogen, raising fears that doctors are over-prescribing the anemia drugs in order to increase profits. Panel members suggested bundling dialysis and drug reimbursement together into a single fee so that the incentive for overusing the drug is diminished. The Government Accountability Office offered a similar recommendation.

Critics of the current Medicare system claim that it is set up to encourage aggressive use of Epogen, which has clear financial costs and, as recent studies have shown, growing health concerns as well. Two studies in the New England Journal of Medicine last month have called into question the overuse of drugs in the treatment of anemia in kidney patients. Scientists have found that anemic kidney patients are susceptible to heart problems or death when aggressively treated with these drugs. The drugs are intended to boost hemoglobin in anemic patients, but the increase in hemoglobin is associated with other serious risks.

Earlier in November, California Congressmen Bill Thomas and Pete Stark, both members of the House Ways and Means Committee, accused Medicare of failing to “stem the systemic abuse of Epogen, resulting in costs to taxpayers and potential health dangers to patients,” according to the Boston Globe.