title: Erythropoiesis-stimulating agents in a meta-stable state: guidelines, economics, and policy in flux.
abstract: Medicare coverage of erythropoiesis-stimulating agents is a complex issue with implications for a variety of healthcare stakeholders. In the first part of the interview (see AHDB, May 2008), Samuel M. Silver, MD, PhD, examined the evolution and clinical implications of the Medicare coverage decisions and the eventual shift in clinical practice away from the approved indication to situations involving quality-of-life issues. In this second part, Dr Silver discusses with F. Randy Vogenberg, RPh, PhD, the clinical implications of the Medicare coverage decision regarding erythropoiesis-stimulating agents, pointing out the noneconomic reasons why transfusions can be risky to cancer patients, and how such policy decisions can have profound implications for patients. Dr Silver calls for new studies to be Initiated, which would be funded by the 2 major manufacturers of these drugs, to investigate the concerns regarding tumor progression and thromboembolic events that are potentially associated with these expensive and potentially toxic medications. The discussion resumes where Dr Silver explains why it would be good to compare claims data of cancer patients who are receiving these medications and their transfusion requirements.