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Friday, 20 Oct 2017

Least Costly Alternative and Medicare

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Despite victory in the courts, there continue to be efforts to apply Least Costly Alternative (LCA) when it should not be applied. Choosing based on cost between equal treatments in one thing, but choosing a treatment that may be inferior simply because it costs less is another, and is poor health policy, and dangerous for the patient.

Major Court Victory: A major victory for victims of prostate cancer and for others who seek the best treatment this country can offer. A patient on Medicare was denied payment of treatment prescribed by her physician and sued in federal court. Medicare invoked Least Costly Alternative as justification for the denial. As explained in the appellate court's decision, under that policy, Medicare provides reimbursement for treatments only up to the price of their “reasonably feasible and medically appropriate” least costly alternatives. She won in federal district court, Medicare appealed the decision, and she won again in the Court of Appeals.

The prostate cancer education and advocacy community called for this change in their Joint Policy Statement in April of 2009.

You can read the judgment and decision here. If you are on Medicare please take note of this decision and share it with your health care provider.