Opinion: CMS shouldn’t be paying for higher-than-necessary doses of cancer drugs
Opinion argues CMS should enforce Medicare Part D coverage limits to doses that are "reasonable and necessary," rather than the FDA -approved maximum tolerated doses. The piece cites Project Optimus and a Kisqali 600 mg versus 400 mg trial showing equivalent efficacy but lower toxicity at 400 mg, notes MDPNP negotiated price cuts, and estimates additional savings (about one-third for Kisqali) if CMS covers lower dosing; authors include the Optimal Cancer Care Alliance and critique routine excessive oncology dosing.
Why it mattersCMS could limit Medicare Part D coverage to lower doses like Kisqali 400 mg, saving roughly one-third of drug costs.
Entities Mentioned
CMSFDAOptimal Cancer Care Alliance
People Mentioned
Mark J. RatainDavid A. Hyman