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Xigris Medicare “Add-On” Payments Approved; CMS Estimates 50,000 Cases

Executive Summary

The Centers for Medicare & Medicaid Services is estimating that the Medicare market for Lilly's Xigris will be $340 mil. in fiscal year 2003

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CMS predicts fewer Xigris patients

Centers for Medicare and Medicaid Services is revising downward estimates for add-on payments for Lilly's Xigris (drotrecogin alfa). Agency estimates 14,000 Medicare patients will be administered therapy in fiscal 2004 compared to 22,000-patient estimate for FY 2003. CMS' original 2003 payment estimate assumed 50,000 Medicare patients (1"The Pink Sheet" Aug. 5, 2002, p. 18) Xigris sales have not matched Lilly's expectations (2"The Pink Sheet" Nov. 18, 2002, p. 22)...

CMS predicts fewer Xigris patients

Centers for Medicare and Medicaid Services is revising downward estimates for add-on payments for Lilly's Xigris (drotrecogin alfa). Agency estimates 14,000 Medicare patients will be administered therapy in fiscal 2004 compared to 22,000-patient estimate for FY 2003. CMS' original 2003 payment estimate assumed 50,000 Medicare patients (1"The Pink Sheet" Aug. 5, 2002, p. 18) Xigris sales have not matched Lilly's expectations (2"The Pink Sheet" Nov. 18, 2002, p. 22)...

Zyvox Medicare “Add-On” Payments Denied; CMS Wary Of Precedent

The denial of Medicare "add-on" payments for Pharmacia's Zyvox reflects CMS' desire to avoid a precedent that could make numerous older therapies eligible for enhanced reimbursement, the agency said in an Aug. 1 final rule implementing changes to the hospital in-patient payment system

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