Amgen, J&J Anemia Drugs Limited by California Insurer (Update3)
By Luke Timmerman
July 16 (Bloomberg) -- Blue Shield of California, a nonprofit insurer with 3.3 million members, is limiting payments for anemia drugs from Amgen Inc. and Johnson & Johnson, medicines that at high doses are tied to heart attacks and stroke.
Blue Shield this month began requiring that doctors wait until a patient's anemia is just shy of requiring a transfusion before giving them Amgen's Aranesp and Epogen, or Johnson & Johnson's Procrit. The policy, posted online on July 2, also said Procrit was the group's preferred medicine.
The decision is the first of several attempts by health plans to lower expenditures for the drugs, which stimulate red blood-cell production. In May, federal health insurers, who paid $2 billion last year for Epogen alone, proposed similar limits that may begin next month. U.S. warnings on the drugs' heart risks could cut revenue for Amgen, the world's largest biotech company, by as much as $1.3 billion this year, analysts say.
``We were astounded that Blue Shield of California has made such a policy decision,'' said Peter Eisenberg, a cancer doctor in Marin County, California, in an e-mail. The policy is ``draconian'' because more anemia patients will need blood transfusions, he said.
Shares of Amgen, based in Thousand Oaks, California, fell 90 cents, or 1.6 percent, to $56.03 at 4 p.m. New York time in Nasdaq Stock Market trading. The stock is down 18 percent this year. The shares of New Brunswick, New Jersey-based J&J rose 37 cents to $63.80 in New York Stock Exchange trading. J&J's stock has fallen 3.4 percent this year.
Public Comment
Amgen spokeswoman Trish Hawkins said about 1,800 doctors, nurses and patient advocates have provided public comment since Medicare, the U.S. health plan for the elderly and disabled, made a similar proposal in May. The ``overwhelming majority'' are opposed to limiting use of the drug below anemia levels in place before the San Francisco-based Blue Shield change, she said.
Anemia, a lack of oxygen-carrying red blood cells, causes weakness and fatigue. The drugs from Amgen and J&J are designed to boost concentrations of hemoglobin, a protein that carries oxygen in the bloodstream.
Blue Shield says it won't pay for the drugs until hemoglobin levels fall to less than 9 grams a deciliter of blood for patients without heart disease, rather than 10 grams. David Seldin, a spokesman, wouldn't say how much money the policy may save, saying it was based on ``medical evidence only.''
Guidelines from the American Society of Clinical Oncology, or ASCO, based in Alexandria, Virginia, say patients should get an anemia drug when hemoglobin falls below 10 grams, Eisenberg said.
Significant Difference
The difference between 10 grams and 9 grams is significant, because the anemia drugs take time to work, Eisenberg said. That means that the anemia drugs may not be able to prevent a patient from slipping to 8 grams a deciliter or lower, where a transfusion is generally required, he said.
Blue Shield also says it won't pay for the anemia drugs if patients are taking certain cancer medicines, including Genentech Inc.'s Avastin for colon and lung cancers, or ImClone Systems' Erbitux for colon cancer.
The U.S. Centers for Medicare and Medicaid Services, based in Baltimore, which administers federal health insurance plans, also is considering that policy. ASCO, the largest U.S. group of cancer doctors, opposes it.
``There is no basis in law or medical evidence to support such restrictions, and ASCO strongly opposes them,'' Joseph Bailes, chairman of the cancer group's government-relations council, said in a June 8 letter to the Medicare agency. Bailes added that the action creates ``the perception that restrictions are proposed for the sole purpose of limiting expenditures.''
Taxpayer Money
Blue Shield of California's decision follows a recommendation from the national Blue Cross Blue Shield Association's medical advisory panel, and from the Medicare Services agency, Blue Shield's Seldin said in a telephone interview.
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Amgen, J&J Anemia Drugs Limited by California Insurer (Update3)
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