Aetna follows CMS lead in ESA restrictions

Executive Summary

Aetna has altered its coverage of erythropoiesis-stimulating agents in certain indications in the non-renal setting to mirror changes made by CMS in its final national coverage determination, issued July 30 (1"The Pink Sheet" Aug. 6, 2007, p. 21). Aetna describes the eight non-renal indications CMS considers not reasonable and necessary as "experimental and investigational." In its update, Aetna said the changes were "based upon guidelines" from CMS. The NCD itself has come under increased scrutiny as of late, with congressional action recently initiated that potentially render the NCD invalid (2"The Pink Sheet" Oct. 1, 2007, p. 16)...