NCPA - National Center for Policy Analysis

Medicare Denies Seniors New Medical Technology

August 16, 2000

The Food and Drug Administration (FDA) has been criticized for delaying approval of new, potentially lifesaving technologies by several years -- but even FDA approval doesn't mean innovative technology is available for seniors covered by Medicare. Beneficiaries of the government health care program may wait additional years for the Health Care Financing Administration (HCFA), which runs Medicare, to allow patients access to the technology.

According to a new report by the Lewin Group for AdvaMed, the process for determining coverage, coding and payment levels for medical technology is overly complicated and time-consuming:

  • Medicare takes 15 months to 5 years to add new technologies for its patients, says the Lewin Group, a health care consulting firm.
  • For instance, an advanced bone density scanning technology for osteoporosis languished for seven years and through six "technology assessments" beyond FDA approval before Medicare was forced to approve coverage by Congress.
  • Medicare approval for a new, less invasive treatment for benign prostatic hyperplasia, non-cancerous enlargement of the prostate mostly in elderly men, was delayed up to two years.
  • Although 54 percent of all patients eligible for cochlear implants -- which can restore hearing to severely deaf people -- are covered by Medicare, only 12 to 15 percent of implant patients are on Medicare, because providers lose $5,500 to $9,000 for every implant due to below-cost reimbursement levels.
  • Medicare took several years to update reimbursement levels as implantable defibrillators -- devices that treat a patient's irregular heartbeat - became more advanced, creating patient access problems for life-saving technology.

Increasingly, Medicare has required significantly more and different evidence than the FDA. While in theory the process can be accomplished in 90 days to 12 months, in practice it can take five years or more.

Source: The Lewin Group "Medicare Patient Access to Technology," Advanced Medical Technology Association (AdvaMed), Washington, D.C.


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