Finally beginning to understand the Avastin/No Avastin Issue

I belong to two local support groups, and of course many of the same people are in both. One member, whom I have never met, recently posted that she was going to Illinois (we live in Texas) so she could get Avastin. That made no sense to me, so today I asked some of the other ladies and this is what I found out: Medicare will pay for Avastin for OVCA in some states, but not all. Am I the only one that did not know this? Here's a cut-and-paste...

Washington, Oct 23, 2009 - Congresswoman Betsy Markey today led a bi-partisan group of 30 House members in sending a letter to TrailBlazer Health Enterprises and the Centers for Medicare and Medicaid Services (CMS), urging them to approve the off-label use of Avastin (bevacizumab) for treatment of ovarian cancer in Texas, Oklahoma, New Mexico, and Colorado. The treatment is already approved in at least 29 other states.

Avastin is covered by Medicare for ovarian cancer treatment in many states, but not the four states in TrailBlazer’s jurisdiction. This is because CMS guidance gives the contractor wide discretion for off-label uses, and TrailBlazer Health has informed patients that it will only reconsider its denial of Avastin coverage through the standard claim appeals process.

“Every year, more than 20,000 women are diagnosed and 15,000 women will die from ovarian cancer,” said Rep. Markey. “This is an issue of fairness in coverage of this important therapy. The women in Colorado who face long and uncertain treatments for ovarian cancer deserve to have the same access to this potentially life-saving treatment as women enrolled in Medicare in other states.”

In July, Michael Bennet, U.S. Senator for Colorado, sent a letter pushing for CMS to require the company to approve Avastin for use by ovarian cancer patients in the state.

“Denying access to a proven cancer drug just because you happen to live in Colorado is absurd and unfair,” Bennet said. “All women should have access to these treatments – no matter what state they live in,” Bennet said. “I will continue working with Congresswoman Markey and push to put an end to this patchwork of coverage that does nothing but tie the hands of our doctors and deny ovarian cancer patients much needed treatment.”
“Without the leadership of Congresswoman Markey and Senator Bennet, our loved ones fighting ovarian cancer in Colorado will continue to be denied coverage for Avastin – a potentially life-saving treatment that is covered in every other state,” said Karen Orloff Kaplan, MSW, MPH, ScD, Chief Executive Officer of the Ovarian Cancer National Alliance. “We are extremely grateful for their desire to right this wrong and ensure that women are able to receive their doctor-prescribed treatment.”