To understand how the Centers for Medicare and Medicaid Services (CMS) approaches its responsibilities regarding the coding, coverage, and payment of medical services--and uses these authorities to pursue its policy prerogatives--consider the circumstances surrounding the pharmaceutical company Sepracor (Marlborough, MA) and its drug Xopenex (levalbuterol).
Xopenex is an innovative respiratory medicine that competes with the chemically distinct and much cheaper generic drug albuterol. Both are delivered as inhaled aerosols and used to treat asthma and chronic obstructive pulmonary disease. It is widely agreed that Xopenex has the same benefits as albuterol. However, some believe Xopenex has fewer of the cardiac adverse effects of albuterol. Medicare did not agree.
Read more at the Journal of Oncology Practice here.