ASH, NCCN, & UHC News

The following information has been received by ANCO.


****ASH NEWS****
The American Society of Hematology's (ASH) Practice Update was published recently and is available online at http://www.hematology.org/policy/practice. This edition features:

President-Elect Obama Nominates Daschle for HHS Secretary

Medicare Releases E-Prescribing Measure

New Report Analyzes 2007 PQRI Program Reporting Experience

ASH Submits Comments in Support of Iron Serum Study NCD

ASH Launches New Practice Page

Value-Based Purchasing Plan for Physicians Under Development at CMS


****NCCN NEWS****
NOW ON LINE! Northern California Cancer Center’s 2nd Annual Cancer Survivorship Conference held on November 8, 2008

To listen to and view go to www.nccc.org. and click on “Program Presentations” or http://www.nccc.org/site/c.foJNIXOyEpH/b.2913703/

Another Multiple Choice Test
Joan Venticinque, Cancer Survivor

Psychosocial Issues
Jeremy E. Bornstein, PhD, CPMC

A Life on Hold
Gregg Timmons, Cancer Survivor

Medical Issues
Sandra Horning, MD/Stanford

Transitioning from Oncologist to Primary Care Doctor
Judy Luce, MD/UCSF

Please mark your calendars! The 3rd Annual Post-Treatment Cancer Survivorship Conference is scheduled for November 14, 2009.


****UHC NEWS****
UnitedHealthcare is removing the requirement to submit a pathology report to obtain coverage for trastuzumab. This change will be effective for claims submitted after 1/1/2009.

Herceptin claims that were submitted in 2008 that are pending payment will require the submission of the pathology report showing over expression of the HER2 gene. The pathology reports should be faxed to 915-231-1970 and you should use the dedicated fax cover sheet.

Herceptin claims submitted after 1/1/2009 will continue to be subjected to two reimbursement policies that may impact the reimbursement. The National Comprehensive Cancer Network (NCCN) policy and the Maximum Dosage Edit policy both review Herceptin claims. Both of these policies are posted on the unitedhealthcareonline web site.

UnitedHealthcare launched the Herceptin policy in early 2006 based on an audit showing that 12 percent of the patients being treated with trastuzumab did not have over-expression of the HER2 gene. Our last audit in September 2008, demonstrated that less than 1 percent of the submissions failed to show over- expression.

Our medical policy hasn’t changed – treatment of patients with under-expression is still inappropriate. We believe the recent audit demonstrates that this quality parameter is being followed and no longer requires the quality check.

There are other critical issues with HER2 gene expression testing. Studies show that concordance between local laboratories and a central laboratory with quality controls can be poor. The College of American Pathology has established accreditation for HER2 gene testing, but participation in the accreditation process is voluntary. UnitedHealthcare contracts with two national laboratories, Genezyme and Lab Corporation that meet the ASCO / CAP guideline recommendations and proficiency testing for HER2. We encourage the use of laboratories that meet these standards. If you don’t know the accreditation status of your current lab for HER2, we would encourage retesting, or a second opinion, from either of these laboratories for your UnitedHealthcare patients.