Update to Local Coverage Determination for Luteinizing Hormone-Releasing Hormone Analogs in the Treatment of Prostate Cancer

• Alabama – L6475
• Georgia – L20069
• Mississippi – L18126

Effective: January 1, 2007

Notification of the final Local Coverage Determination for Luteinizing Hormone-Releasing Hormone Analogs in the Treatment of Prostate Cancer was published in the November 2005 issue of the Medicare newsletter. Under the ‘Limitations’ section, the LCD states that payment of these drugs will be according to the allowed amount of the lower-priced medication. Due to our LCD requirements to use the injectable form of this drug in certain circumstances, the LCD is being revised to separate the LHRH drugs into two groups for pricing purposes based upon their duration, and to implement a ‘Least Costly Alternative (LCA)’ for each group.

Group 1 includes the short acting LHRH agents (less than 12 month duration):

• J3315 - Injection, triptorelin pamoate, 3.75 mg - (Trelstar Depot, Trelstar LA)
• J9202 - Goserelin acetate implant, per 3.6 mg - (Zoladex)
• J9217 - Leuprolide acetate (for depot suspension), 7.5 mg - (Lupron, Eligard).

Group 2 includes the agents with a 12-month duration (yearly implants):

• J9219 - Leuprolide acetate implant, 65 mg - (Viadur)
• J9225 - Histrelin implant, 50 mg - (Vantas)

LCA pricing for each group is based on the quarterly lowest ASP (average sales price) priced drug in each group. Consequently, the LCA is subject to change.

Paragraph #2 under the ‘Limitations’ section of the LCD has been revised accordingly.

This revision will be effective for claims with dates of service January 1, 2007 and after.

A copy of the updated Local Coverage Determination can be found at https://www.cahabagba.com. Click on your state for the information you need.