Blue Shield of California Drops Coverage of Breast Cancer Drug October 3, 2011 News Avastin, Blue Shield 0 Blue Shield of California will cease reimbursement for use of the drug Avastin to treat breast cancer on October 17. Three other insurers that had decided not to pay—Regence, which operates Blue Cross Blue Shield plans in the Northwest; Excellus BlueCross BlueShield in Rochester; and Dakotacare in South Dakota. Blue Shield, with 3.2 million members, is the first large insurance company to end payments since a federal advisory committee unanimously recommended that the Food and Drug Administration (FDA) rescind Avastin’s approval as a treatment for breast cancer. To date, the FDA has not made a final decision. Because it is an emotional and politically contentious issue, with some women saying the drug is keeping them alive, many insurers have said they will wait until a final decision from the FDA before re-evaluating their coverage policies. Medicare has indicated it will continue paying for the drug even if the FDA revokes the approval. Avastin, which is sold by Genentech, is approved to treat other forms of cancer and will remain on the market even if its approval for breast cancer is revoked. Doctors could prescribe the drug to treat breast cancer even if it were not approved for the disease. But some patients and doctors say that insurers would be less likely to pay for such off-label use. That would put Avastin, which costs about $88,000 a year, out of reach for many women. Shortly after the FDA advisory committee’s negative vote, a panel of breast cancer doctors convened by the National Comprehensive Cancer Network, an organization of major cancer hospitals, reaffirmed that Avastin was “an appropriate therapeutic option for metastatic breast cancer.” That is important because Medicare and UnitedHealthcare are supposed to pay for drugs listed in the cancer network’s guidelines. Click here to view the notification from Blue Shield. Comments are closed.
