Albuterol drops to 11 cents

WASHINGTON - When the latest average sales price figures for neb meds were released in March, providers' jaws dropped nearly as low as the reimbursement for albuterol (from $1.11 to 11 cents). "You can't buy albuterol that cheap," said Sam Jarczynksi, president of RxStat in St. Petersburg, Fla. "From the start it's a loss." Also taking a huge hit: Xopenex, which dropped from $1.11 to about 70 cents. "We had the demise of Xopenex already," said Wayne Vega, vice president of sales for Harvard Drug Group. "This is just a nail in the coffin." The steep drop for both drugs comes courtesy of a provision in the SCHIP bill-signed late last year-which enabled Medicare to revamp how it calculates ASP for the two drugs. The drugs once again have individual codes, but while albuterol's (J7613) ASP is calculated by itself, Xopenex's (J7612) is calculated along with albuterol. Most industry watchers had expected that methodology to hold Xopenex steady, said Mickey Letson, president of Decatur, Ala.-based Letco Companies. "It's very shocking," he said. "Everybody is becoming very upset about the process. Medicare said (the ASP model) would stabilize reimbursement but it's done anything but." After a steep drop the previous quarter, DuoNeb stayed stable at 83 cents per dose, leading to speculation that providers would begin switching patients to it. Such thinking is short-sighted, says Vega. "Pharmacies need to have a mixture of drugs based on the best clinical advantage for the patients and a long-term strategy," said Vega. "Instead of having all your eggs in one basket, mix your base drug with the long-acting beta agonists (LABA) drugs." LABA drugs fared better in the latest ASP figures: Brovana, $4.74; and Perforomist, $4.93. Ipratropium and budesonide remained steady at 21 cents and $5.08. HME