Payers Covering Avastin Despite FDA Recommendation

The U.S. Food and Drug Administration (FDA) is recommending removing the breast cancer indication for Avastin (bevacizumab). To date, however, payers aren’t saying they will discontinue coverage.

Some payers, in fact, are taking the National Comprehensive Cancer Network’s (NCCN) word over the FDA’s. According to Bloomberg Businessweek, several major insurers, including Wellpoint Inc. and UnitedHealth Group, say they will continue paying for Genentech’s Avastin for the treatment of breast cancer based on NCCN recommendations. Genentech is a member of the Roche Group.

Centers for Medicare & Medicaid Services (CMS) spokesman Don McLeod told Bloomberg Businessweek, “Most if not all” regional contractors for CMS still pay for Avastin (HCPCS Level II code Q2024 Bevacizumab injection) in breast cancer while the FDA reviews Genentech’s repeal.

Bevacizumab inhibits angiogenesis — the uncontrolled spread of blood vessels feeding cancer tumors and diabetic retinal proliferation in the eye. According to the FDA, there is no supporting evidence that Avastin used to treat breast cancer in women prolongs overall survival or slows down disease progression. The benefits do not outweigh the risks, the FDA said in December 16, 2010 news release.

The FDA is recommending oncologists use their medical judgment when deciding whether a patient should continue using the drug for treatment of metastatic breast cancer.

Avastin is used for treating many cancers, and the FDA decision does not affect coverage for those cases.

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