Agency Overreach Leaves Patients Untreated

Medicare coverage for new treatments takes years. Thanks, CMS.

By Joseph Grogan. He is a senior visiting scholar at University of Southern California’s Schaeffer Institute. Excerpts:

"the Coverage and Evidence Development program at the Centers for Medicare and Medicaid Services." 

"The program took a turn for the worse under the Obama administration. CMS abused CED to stifle access to FDA-approved products, from heart valve replacements to PET scans diagnosing Alzheimer’s disease, restricting Medicare coverage. Under the Biden administration, CMS applied CED for the first time to medications—which restricted coverage for an entire class of new Alzheimer’s therapies."

"Of 27 medical devices covered under CED since 2005, four have “graduated” to unrestricted coverage. Two product decisions were ceded to Medicare’s regional administrative contractors. The other 21 remain in limbo."