Least Costly Alternative and Medicare

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Irene Hayes, was denied payment of treatment prescribed by her physician and sued in federal court.  Medicare had decided to only pay for the Least Costly Alternative (LCA), a treatment that her physician thought inadequate.  As explained in the appellate court’s decision, under that policy, Medicare provides reimbursement for treatments only up to the price of their “reasonably feasible and medically appropriate” least costly alternatives. She won in federal district court, Medicare appealed the decision, and she won again in the Court of Appeals.

This is not just a victory for Irene Hayes but for Medicare beneficiaries everywhere, and especially for men who suffer from prostate cancer.  Medicare has a history of using Least Costly Alternative to deny payment of more costly, but effective, treatment of prostate cancer.  

By | 2017-10-19T10:54:13+00:00 January 15th, 2010|Activism, Treatment News|1 Comment

About the Author:

Malecare is the world's leading men's cancer support and advocacy nonprofit organization.

One Comment

  1. mcarforsou December 14, 2010 at 8:53 pm

    ” Medicare has a history of using Least Costly Alternative to deny payment of more costly, but effective, treatment of prostate cancer.”
    Are you sure that this is true?

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