CMS Likely To Deny Coverage For Pricey New Treatments

According to a new analysis on national coverage decisions between 1999 and 2012, getting medical devices, drugs and procedures covered by Medicare is becoming more difficult. In order to justify the cost, CMS requires more evidence that the new interventions are “reasonably necessary” and should be paid under the federal healthcare program. CMS is about 20 times more likely to say no in more recent years. Researchers analyzed 213 decisions made between 1999 and August 2012 and found that a total of 74 were denied coverage during that time period. The majority of the denials happened in more recent years with Medicare being less likely to pay if there were alternative interventions and no estimate of cost-effectiveness.

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