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California insurance company won’t cover cancer drug Avastin

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Blue Shield of California says as of October 17, 2011, it will no longer pay for the cancer drug Avastin to treat metastatic breast cancer.

The decision, announced on the company’s web site, comes after the Food and Drug Administration (FDA) Advisory Committee ruled unanimously in June the popular, but expensive, drug should be
for use for breast cancer because it is “neither safe nor effective.”

For now, breast cancer patients using Avastin, the best-selling cancer drug in the world, should still be eligible to receive insurance coverage for the $8,000 per month medication pending a final decision by FDA Commissioner Margaret A. Hamburg.

The debate over Avastin’s breast cancer benefits has been a highly emotional and politically contentious issue. So much so, that many insurers have said they will wait for the FDA’s decision before determining if they will continue to pay for the drug.

Medicare has said it will continue to cover the drug for breast cancer regardless what the FDA decides.

If the FDA rules against Avastin for breast cancer use, it will not pull the drug off the market, but rather will limit its use for colon, kidney, brain and lung cancers. Doctors can continue to prescribe Avastin for breast cancer “off label” or for an unapproved use, but insurers are unlikely to pay for it.

Some breast cancer advocates fear now that Blue Shield — one of California’s largest insurers with 3.3 million members — has withdrawn coverage, other insurers will follow suit. They say without insurance coverage, women already taking the drug, but who can’t afford the drug’s high price tag, will be left with few options.

Blue Shield of California joins three other companies: Regence, which operates Blue Cross Blue Shield plans in the Northwest, Excellus Bluecross Blue Shield in Rochester, and Dakotacare in South Dakota, which have also decided not to pay, the New York Times reports.

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