Limit Relaxed for Medicare Payments of Epogen

Medicare has decided to broaden its criteria for payment of Amgen’s top drug, the anemia treatment Epogen.

The Health Care Financing Administration, which runs Medicare, indicated in March that it would raise the limit on red blood cell production for Epogen users. The agency recently sent a letter to insurers about the change, Amgen said.

“It’s the first time they agreed to the change in writing,” said David Kaye, a spokesman for the Thousand Oaks-based Amgen.

Epogen made up almost half of Amgen’s $2.4 billion in 1997 revenue. Many of the drug’s sales are made through Medicare, the government health insurance program for the elderly and disabled.

In 1997, the government said it would reject payment for Epogen use in cases where red blood cells exceeded 36.5% of the total volume of a patient’s blood, on average, during a 90-day period. The limit has been raised to 37.5%, giving doctors a cushion in using Epogen to stimulate production of red blood cells, Kaye said.

In men, red blood cells usually make up 43% to 49% of total blood volume. In women, red blood cells usually make up 37% to 43%.

Amgen sells Epogen in the United States for use in patients with kidney disease. Its marketing partner, Johnson & Johnson, sells the drug under the name Procrit for all other uses.