Medicare Contractors should pay for Avastin

I have been following the discussions on the difficulties many of us have had getting Avastin (Bevacizumab) paid for by Medicare. It appears as if the contractors in some states (Trailblazers seems to be one of them) ignore the new guidelines put out by Medicare in June of 2008 and reported on in the NY Times and the Wall Street Journal in Jan 09. Another editorial entitled "Cancer Patients Deserve Faster Access to Life Saving Drugs” written by Richard Epstein, a professor of law at the University of Chicago appeared on May 2, 2009 in the Wall Street Journal.

Medicare clearly stated in 2008 that NCCN would be an accepted entity and they would abide by its recommendations. Yet some contractors/states are dragging their feet in following Medicare’s directives.

Follow the directions below - web addresses - and you will find the exact language the NCCN uses to recommend Avastin for recurrent ovarian cancer.

http://www.nccn.org/professionals/drug_compendium/content/contents.asp.
Scroll down until you find Bevacizumab.

Click on Bevacizumab - you will then see a list of various conditions for which the drug is recommended.

Scroll down to ovarian cancer – (the conditions are arranged alphabetically).

Note that "ovarian cancer" isn't mentioned in the "FDA Disease Indication" column but in the "NCCN Recommended Use" column. Under that
Column, note the following:

"Recurrence therapy as a single agent for the following indications:

..Recurrence as evidenced by serially rising CA- 125 in patients who have received prior chemotherapy

.progressive or stable disease on primary therapy

.relapse after being in complete remission following primary chemotherapy

.stage II to IV disease showing partial response to primary treatment”

These recommendations seem very clear to me and I hope they will help any of you who are arguing with Medicare's contractor in your state about paying for Avastin.

It simply isn't fair that contractors get to decide how to spend our money, ( actually all tax payers’ money as Medicare is a federal program), by declining claims and appeals for Avastin for ovarian cancer in their states while women in other states have their paid for.

All of us should write letters to the editors of our local newspapers, write our congress people, notify our state's insurance commissioner, write the President and Oprah and raise awareness any place we can about this dilemma. I know that people in Colorado, Oklahoma, New Mexico and Texas have complained about Trailblazer's lack of responsiveness but I believe this happens with other contractors in other states as well.

If we want this fixed, we really must do it ourselves and convince others to help us! We can win our fights against ovarian cancer but we need the proper tools – Avastin is one – to do so! So let’s fight for what is rightfully ours!