Aprepitant for Chemotherapy-Induced Emesis

CMS National Coverage Determination | ncd_id=309 | manual_section=110.18 | coverage_level_code=2 | national_coverage_type=True | under_review=True | lab_ncd=False

B. Nationally Covered Indications Effective for services performed between April 4, 2005, and May 28, 2013, the Centers for Medicare & Medicaid Services makes the following determinations regarding the use of aprepitant in the treatment of reducing chemotherapy-induced emesis: The evidence is adequate to conclude that the use of the oral antiemetic three-drug combination of oral aprepitant (Emend®), an oral 5HT 3 antagonist, and oral dexamethasone is reasonable and necessary for a specified patient population. We have defined the patient population for which the use of the oral antiemetic three-drug combination of oral aprepitant (Emend®), an oral 5HT 3 antagonist, and oral 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 Effective for services performed on or after May 29, 2013, the oral three-drug regimen of oral aprepitant, an oral 5HT 3 antagonist and oral dexamethasone is reasonable and necessary for beneficiaries receiving, either singularly or in combination with other drugs the following anticancer chemotherapeutic agents: Alemtuzumab Azacitidine Bendamustine Carboplatin Carmustine Cisplatin Clofarabine Cyclophosphamide Cytarabine Dacarbazine Daunorubicin Doxorubicin Epirubicin Idarubicin Ifosfamide Irinotecan Lomustine Mechlorethamine Oxaliplatin Streptozocin The oral three drug regimen must be administered immediately before and within 48 hours after the administration of these chemotherapeutic agents. C. Nationally Noncovered Indications The evidence is adequate to conclude that aprepitant cannot function alone as a full replacement for intravenously administered antiemetic agents for patients who are receiving highly emetogenic chemotherapy and/or moderately emetogenic chemotherapy. Medicare does not cover under Part B for oral antiemetic drugs in antiemetic drug combination regimens that are administered in part, via an oral route and in part, via an intravenous route. Medicare does not cover under Part B aprepitant when it is used alone for anticancer chemotherapy related nausea and vomiting. D. Other Medicare Administrative Contractors may determine coverage for other all-oral three-drug antiemesis regimens of aprepitant or any other FDA approved oral NK-1 antagonist in combination with an oral 5HT 3 antagonist and oral dexamethasone with the chemotherapeutic agents listed above, or any other anticancer chemotherapeutic agents that are FDA approved and are defined as highly or moderately emetogenic. (Last revised May 2013)