News & Events

“Cardiology, prostate care

and obstetrics are three examples, among many, of fields where high-cost care often brings no benefit.”

The above sentence was copied and pasted from NYTimes Op-Ed Columnist David Leonhardt piece in today’s NYTimes. 

This is an example of why the NYSUrological Society if needed.  Prostate care is no a luxury item in health care. 

Let us not go back to the days of the advanced prostate cancer wards.

Support us by joining us.  Do it now.  

A worthy fight.

Fighting for prior authorization reform–yep
Fighting for liability reform–yep
Fighting for access to prostate cancer screening-yep
Fighting for access to ED medication–yep

The New York State Urological Society fights for your issues and your patients.
Please join us.. We can’t go it alone.

Update on ED Drug Coverage – April 2019

I recently received some updates from Natacha Graham at the AUA regarding insurance coverage for ED care that I wanted to share with all of you:

1. COVERAGE OF ED DRUGS

Blue Cross Blue Shield (BCBS) New York has updated its medical policy for Erectile Dysfunction Agents with the following changes to applicable medications, criteria, and supporting information. They have added generic tadalafil, sildenafil and vardenafil to the policy as plan-preferred.

Coverage is provided in accordance with the following:

*      For Viagra/sildenafil, Levitra/vardenafil, Cialis/tadalafil, Staxyn, Stendra, Muse, Caverject, or Edex for the treatment of erectile dysfunction.

*      For Cialis/tadalafil 2.5mg or 5mg tablets for the treatment of benign prostatic hyperplasia

*      Phosphodiesterase (PDE) inhibitors are not covered for the preservation of penile function after radical prostatectomy, as this is considered investigational.

*      BCBS NY has changed Cialis from plan-preferred to non-preferred status.  Coverage of Cialis, Viagra, Levitra, Staxyn, Stendra, Muse, Caverject, or Edex is available if there is a documented trial (resulting in intolerance or treatment failure) with ONE of the plan-preferred medications (sildenafil, tadalafil, or vardenafil) OR when at least ONE of the following criteria have been met:

*      The plan-preferred medications are contraindicated or will likely cause an adverse reaction by or physical or mental harm to the member.

*      The plan-preferred medications are expected to be ineffective based on the known clinical history and conditions of the member and the member’s prescription drug regimen.

*      The member has tried the plan-preferred medications or another prescription drug in the same pharmacologic class or with the same mechanism of action and such prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event.

*      The member is stable on the medication selected by their healthcare professional for the medical condition under consideration (where “stable” is defined as receiving the medication for an adequate period of time, have achieved optimal response, and continued favorable outcomes are expected UNLESS the medication was initially selected due to the availability of a drug sample or a coupon card and the member does not otherwise meet the definition of “stable”).

*      The plan-preferred medication is not in the best interest of the member because it will likely cause a significant barrier to the member’s adherence or to compliance with the member’s plan of care, will likely worsen a comorbid condition of the member, or will likely decrease the member’s ability to achieve or maintain reasonable functional ability in performing daily activities.

 

 2. TIBIAL NERVE STIMULATION

Health Now Blue Cross Blue Shield of New York has revised their Percutaneous Tibial Nerve Stimulation medical policy with the following changes to the criteria:

*     Changed coverage decision from investigational to medically necessary for percutaneous tibial nerve stimulation for members with non-neurogenic urinary dysfunction when criteria are met;

*     Added position statement indicating medical necessity for maintenance therapy using monthly percutaneous tibial nerve stimulation for members whose urinary dysfunction improved following initial treatment;

*     Revised indications for which percutaneous nerve stimulation is considered investigational, removing all indications aside from neurogenic bladder dysfunction and fecal incontinence.

*     Changed prior authorization status from recommended to not required.

 

 3. CABAZITAXEL

Emblem Health of New York has revised its Jevtana medical policy with the following changes to criteria:

*      Updated initial approval criteria for the use of Jevtana in the treatment of prostate cancer to revise the requirement that the medication will be used in combination, changing the specification of prednisone into any steroid.

*     Revised criterion regarding metastatic disease to change “hormone-refractory” to “castration-resistant.”

 

Most Sincerely,

 

John Phillips, MD, FACS, President, New York State Urological Society

 

 

Open Letter to Department of Health from Dr. Phillips re: lack of a Prostate Cancer prevention agenda for 2019

Dear Dr. LeBlanc,

Thank you for your reply earlier this fall and for providing the linked documents.   On page 7 of the NYS Comprehensive Cancer Control Plan, prostate cancer is listed as the #1 diagnosed solid tumor malignancy in New York State men and the #2 cause of death.  The lack of a universally accepted screening tool should not be the basis to exclude a malignancy of that potential source of morbidity and mortality from a public awareness campaign.     As you well know, the USPSTF based their 2012 recommendations regarding PSA-based prostate cancer screening on two largely flawed studies (PLCO and ERSPC) which were underpowered and poorly controlled.  Death from prostate cancer dropped 50% since the advent of PSA testing and still technology and knowledge advance.  PSA testing has become more refined and and the focus is to identify the risk of clinically significant cancers (i.e. Gleason grade group 2 or higher) not just simply the task of finding ‘any’ prostate cancer.  As such, urologists work to stratify patients for their risk of significant prostate cancer using familial and genetic tools (e.g. BRCA2, p10 deletions), PSA isoform panels such as the 4K score and Prostate Health Inventory (PHI), and, when indicated, multiparametric MRI of the prostate, the first imaging approach that reliably identifies clinically signficant foci of prostate cancer that may merit targeted biopsy.    No assessment of prostate cancer risk, however, can be performed unless patients and stake holders have access to adequate and available information, including PSA testing, and as such would benefit from the kind of coordinated, multisystem effort such as the Department of Health can undertake.   The lack of any such effort, especially for high risk portions of the state, may be doing a disservice to those men who are currently unaware of their potential for having life threatening prostate cancer.  We ask that the Department of Health reconsider their including prostate cancer and current practice guidelines regarding its risk assessment in the NYS Prevention Agenda.

 

Most Sincerely

John Phillips, MD, FACS

Professor, Department of Urology, New York Medical College Program Director, Westchester Medical Center President, New York State Urological Society

Take Action – Contact NY Governor Andrew Cuomo Today!

 

 

Attention New York Urologists –

A bill to mandate that insurance policies that cover prostate cancer screening must do so without cost-sharing is being considered by NY Governor Andrew Cuomo.

The sponsor’s justification states, “…in 2015 the state enacted provisions to ensure women have access to breast cancer screenings at no cost to them. These provisions are especially important in today’s health insurance market-place where more and more individuals are covered by high deductible policies. This legislation, similar to the breast cancer screening provisions enacted in 2015, will ensure men have access to prostate screenings at no cost to them.”

 

Make Your Voice Heard!

 

Send a message to the Governor using this online form:   https://www.governor.ny.gov/content/governor-contact-form

 

Thank You!

LINK TO LEGISLATION:       Legislation: SB6882

 

 

Prostate Cancer Prevention for New Yorkers: An Urgent Need for Your Input!

Dear NYSUS member

The 2nd leading cause of cancer death in American men is prostate cancer.  Many New Yorkers, especially African American men, are at an increased risk of significant prostate cancer.  In some New York counties, African-American men have double the risk of death from prostate cancer. 

It is urgent that as caregivers,  we all contact our state legislators to include prostate cancer in the 2019-2024 Prevention Agenda for the New York State Department of Health (DOH).  Use the following link to find your legislator and then click on the helpful bar to reach their office: 

Find your Assemblyperson – Click Here

You can also email your comments for updating the Prevention Agenda directly to the Ad Hoc Committee leading the Prevention Agenda at:   prevention@health.ny.gov

 

Sincerely,

 

John Phillips, M.D.

President

We Want To Hear From You!

 

Dear Colleague

The annual meeting of the Medical Society of the State of New York in March and the May meeting of the AUA are fast approaching.  Please take 20 seconds to fill out the following survey indicating whether you will be attending either or both events and whether there is an interest in a NYSUS social event at these meetings.

 

https://www.surveymonkey.com/r/GHHHMND

 

Most Sincerely

John Phillips, MD, FACS

CMS Considering Change in Coding Robotic Prostatectomy to an Outpatient Procedure

 

 

Dear Colleagues:

As you may have heard, CMS is considering a change in coding of robotic prostatectomy (CPT 55866) to an outpatient procedure.

We strongly oppose the change as it would significantly impact patient safety and resources to maintain Quality and Improvement (QI) activities, and further require burdensome administrative efforts away from patient care.   The CMS provides a ‘comment period’ during which we ask members to consider providing a response.  Any data that you  may have demonstrating, for example, mean and or median hospital stays for robotic prostatectomy, would be particularly helpful and can be uploaded as a chart, figure, or table.

Here’s how to comment:

1. Please go to and/or click on the following link www.regulations.gov/searchResults?rpp=25&po=0&s=cms-1678-p&fp=true&ns=true

2. Find the Comment Now button on the top right.

3. Enter your response in the provided box that opens.

4. Click on the identifier response boxes as directed.

 

Thank you for your efforts!

John Phillips, MD