CMS rescinds “least costly alternative” policy

Apparently the Centers for Medicare and Medicaid Services (CMS) rescinded the “least costly alternative” policy on April 19 this year.

We don’t seem to have been the only people to have “missed” this announcement since it has only recently appeared in other specialized media like “The Pink Sheet.”

The least costly alternative (LCA) policy had allowed CMS to limit payments for Medicare Part B drugs to the “least costly alternative” in a therapeutic class. It had been used specifically to limit payments for drugs like LHRH agonists, and even to justify the use of orchiectomy as the “least costly” alternative for the hormonal therapy of prostate cancer (most particularly for Medicaid patients in certain states).

America’s Prostate Cancer Organizations (of which Prostate Cancer International is a founding member) and some of its members had long advocated for the elimination of the LCA policy, so we are pleased to recognize CMS’s willingness to rescind this policy. However, it would be unwise to think the LCA might not return under another guise as health care reform processes continue.

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