October 9, 2011 
In case you haven’t seen the news about Genetech’s Avastin, here’s the quick summary:
- An FDA advisory panel has recommended that the drug not be used for breast cancer. (see NYTimes article)
- Medicare has said it would continue to cover the drug regardless of what the FDA does with it’s advisory panel’s recommendation.
- BS of CA has already said it will stop covering Avastin (which costs $8,000 per month). [Regence, Excellus, and DakotaCare were all mentioned as also stopping coverage.]
This will be a hot topic. While it only affects a relatively small group of patients (~17K), this is an emotional issue. Many patients strongly believe in the drug. I would expect companies to be getting lots of questions on the topic.
At the end of the day, if the panel and FDA agree that the drug is not effective, I find it hard to believe that many insurers will cover it or if they do, it will be tightly controlled with prior authorization.
Enabling Healthy Decisions 
One of the few times that my messaging to clients is “don’t use automation…the population is small, the topic is sensitive…reach out with your clinicians and talk to the patients.”
Heard from BS of CA. They haven’t decided to stop covering it. The press is reporting the wrong story. They are going to carefully review new starts.