Al's Comment:

 We need to fight this.  I will provide details next week!

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Posted on: 05/09/2019

 

                                                              Medicare proposal to cover Optune for Glioblastoma

 

Medicare has been reviewing coverage for Optune. They published the proposed rule today.  See    https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=38197&ver=17&DocID=DL34823&SearchType=Advanced&bc=IAAAABAAAAAA&

 

 This was much better than I thought it would be. They propose to approve Medicare coverage for Optune, but set severe restrictions.  The restrictions include that the patient has to be treated at major cancer centers, have a karnofsky score of 70 or better, start within 7 weeks of the end of radiation and not have evidence of progression at that time.

  

There is an open comment period now that ends June 24th, and an open meeting on June 20.  Medicare will consider the comments and come up with a final rule.

 We will have to request most of the restrictions be removed.  I believe that all patients should be treated at the major centers but it just is not practical.  There is no medical reason for that restriction as it is a simple to use treatment that patients do mostly themselves.

 

As to the restriction on no evidence of progression after radiation, a large number of patients have pseudoprogression after radiation and there is no way to prove true progression.  Even if they have progression, I would still use Optune.

Patients with a low Karnofsky have few other options.

 

The time limit will force an ugly choice between clinical trials and Optune.  Clinical trials will be forced to allow use of Optune or the patient will miss the golden opportunity.  That should happen anyway but it is not right for Medicare policy to influence medical decisions.

 

 I would like to discuss this with any interested people,  The braintumor treatment group is the best place to discuss it  https://virtualtrials.com/braintumor-treatments.cfm or contact me at musella@virtualtrials.com

 

We need to come up with good arguments, then I will start a letter writing campaign and invite everyone to help out. It would be a horrible precedent to allow Medicare to tell you where you can be treated and to try to influence your treatment options.

 

 

 

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