CMS Opens National Coverage Determination To Review The Coverage Of Verteporfin

The Centers for Medicare & Medicaid Services (CMS) received a formal written request from the American Academy of Ophthalmology for review and rescission of NCD 80.3.1 on May 25, 2012 and therefore decided to open a National Coverage Analysis (NCA) for the Ocular Photodynamic Therapy (OPT).

“OPT is a treatment for age-related macular degeneration (AMD), a common eye disease among the elderly. AMD is the leading cause of blindness in adults over the age of 50. OPT involves the infusion of an intravenous (IV) photosensitizing drug called Verteporfin followed by exposure to a laser. The laser activates Verteporfin, which selectively targets and treats the pathologic ocular tissue. Verteporfin therapy is neither a cure nor a preventative for AMD; it is meant to slow progression of the disease,” CMS’ Web site says.

CMS has expressed interest in “receiving evidence speaking to the need for fluoresce in angiography with OPT in patients for whom targeted anti-VEGF intravitreal therapy has failed.” The initial 30-day public comment period began July 24, 2012 and will end on August 23, 2012.

Visit http://www.cms.gov/medicare-coverage-database/details/nca-tracking-sheet.aspx?NCAId=262&fromdb=true for more information and http://www.cms.gov/Medicare/Coverage/InfoExchange/publiccomments.html for comments.