The Centers for Medicare & Medicaid Services (CMS) has opened a National Coverage Analysis (NCA) for the Ocular Photodynamic Therapy (OPT) National Coverage Determination (NCD 80.3.1) after receiving a formal written request from the American Academy of Ophthalmology on May 25.

OPT is a treatment for age-related macular degeneration (AMD), a common eye disease among the elderly. AMD is the leading cause of blindness in adults over the age of 50. OPT involves the infusion of an intravenous (IV) photosensitizing drug called verteporfin followed by exposure to a laser. The laser activates verteporfin, which selectively targets and treats the pathologic ocular tissue. Verteporfin therapy is neither a cure nor a preventative for AMD; it is meant to slow progression of the disease.

The American Academy of Ophthalmology notes that the current coverage decision for OPT is from 2004, prior to the emergence of targeted anti-VEGF intravitreal treatments, and that these newer therapies have largely supplanted OPT as initial management of AMD, and that OPT is largely relegated to patients in whom the newer therapies have failed. The American Academy of Ophthalmology believe that the current NCD requirement for follow-up fluorescein angiography with OPT is not supportable for these end-stage patients.

CMS is interested in receiving evidence speaking to the need for fluorescein angiography with OPT in patients for whom targeted anti-VEGF intravitreal therapy has failed. The initial 30-day public comment period begins July 24, 2012.


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