LCD/NCD Portal

NCD110.18

 

APREPITANT FOR CHEMOTHERAPY-INDUCED EMESIS

 

 

Effective Date of this Version

7/5/2005

 

 

Benefit Category

 

• Oral Antiemetic Drugs.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

 

Item/Service Description

 

General

 

• Chemotherapy-induced nausea and vomiting (CINV) can range from mild to severe, with the most severe cases resulting in dehydration, malnutrition, metabolic imbalances, and potential withdrawal from future chemotherapy treatments.

• The incidence and severity of CINV are influenced by the

o Specific chemotherapeutic agent(s) used.

o Dosage.

o Schedule and route of administration.

o Drug combinations.

• Patient specific risk factors such as sex, age, history of motion sickness, and prior exposure to chemotherapeutic agents can also have an effect on CINV incidence and severity.

• Progress has been made in reducing CINV, although it can still be hard to control symptoms that occur more than a day after chemotherapy, during repeat cycles of chemotherapy, and when chemotherapy is given on more than one day or in very high doses.

o No single anti-emetic agent is completely effective in all patients.

• As noted above, many factors influence the incidence and severity of CINV, with the specific chemotherapeutic agent as the primary factor to consider when deciding which anti-emetic to administer.

• Aprepitant (Emend®) is the first Food and Drug Administration-approved drug of its type.

• Aprepitant has been proposed to function in combination with other oral anti-emetics for a specified population of Medicare patients receiving highly emetogenic chemotherapy.

 

 

Indications and Limitations of Coverage

 

Nationally Covered Indications

 

• Effective for services performed on or after April 4, 2005, the Centers for Medicare & Medicaid Services makes the following determinations regarding the use of aprepitant in the treatment of reducing chemotherapy-induced emesis:

o The evidence is adequate to conclude that the use of the oral anti-emetic 3-drug combination of aprepitant (Emend®), a 5-HT3 antagonist, and dexamethasone is reasonable and necessary for a specified patient population.

o We have defined the patient population for which the use of the oral anti-emetic 3-drug combination of aprepitant (Emend®), a 5-HT3 antagonist, and dexamethasone is reasonable and necessary as only those patients who are receiving one or more of the following anti-cancer chemotherapeutic agents:

 Carmustine.

 Cisplatin.

 Cyclophosphamide.

 Dacarbazine.

 Mechlorethamine.

 Streptozocin.

 Doxorubicin.

 Epirubicin.

 Lomustine.

 

 

Nationally Noncovered Indications

 

• The evidence is adequate to conclude that aprepitant cannot function alone as a full replacement for intravenously administered anti-emetic agents for patients who are receiving highly emetogenic chemotherapy.

 

 

Other

• N/A

• (This NCD last reviewed June 2005.)

 

 

Claims Processing Instructions

• TN 590 (Medicare Claims Processing)

 

 

Coverage Transmittal Link

 

• http://www.cms.gov/transmittals/downloads/R40NCD.pdf

 

 

National Coverage Analyses (NCAs)

 

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Aprepitant for Chemotherapy-Induced Emesis (CAG-00248N) opens in new window

• First reconsideration for Aprepitant for Chemotherapy-Induced Emesis (CAG-00248R) opens in new window

 

 

Medicare NCD Link