July 15 (Reuters) - Vertex Pharmaceuticals ( VRTX ) sued
the U.S. Department of Health and Human Services on Monday,
seeking a court declaration that a fertility support program for
patients who are prescribed its gene editing therapy Casgevy
does not violate federal anti-kickback laws.
Casgevy is approved for the treatment of two genetic
disorders - sickle cell disease and transfusion-dependent
beta-thalassemia - in the United States.
The treatment involves patients receiving high doses of
chemotherapy, with infertility being a potential risk.
While fertility preservation methods such as freezing eggs
and sperm banking are covered under commercial insurance plans,
government-supported plans like Medicaid do not offer coverage.
Vertex offers financial support for some Casgevy patients
who meet certain eligibility criteria.
The Office of Inspector General, named as one of the
defendants in the lawsuit, had previously conveyed to the
company that its program could violate anti-kickback laws as it
"poses more than a low risk of fraud and abuse to federal health
care programs".
The OIG and other defendants in the lawsuit - the HHS,
Secretary Xavier Becerra and Inspector General Christi Grimm -
did not immediately respond to requests for comment.
Anti-kickback provisions prohibit "quid-pro-quo"
transactions, in which remuneration, such as a bribe or
kickback, is sought or offered to influence medical decisions.
Vertex said anti-kickback laws do not prohibit support such
as the one its program provides.
The program "removes a financial or medical barrier to care
and thereby allows patients to receive appropriately prescribed
medical treatment," the company said in the court filing.
The lawsuit was filed in the federal court in Washington,
D.C.