ASP pricing contains pleasant surprises
By HME News Staff
Updated Mon January 31, 2005
WASHINGTON - The ASP pricing for inhalation medications released by CMS in December included some surprises for the industry with several of the price points diverging drastically from original calculations.
One surprise was the increase in the reimbursement for albuterol to seven cents per milligram.
“Wow. That's high. That's way up,” said one industry insider. “Originally they were talking four cents and then in the last price that was published they were saying five cents. Now, they have gone all the way up to seven. That's a huge, huge increase.”
The monthly allowable for albuterol, including the $57 per month dispensing fee, will be $78, which is higher than ipratropium bromide's $74.20 monthly allowable. Ipratropium will be reimbursed at 29 cents per milligram, down from an expected reimbursement of 45 cents per milligram.
“Ipratropium bromide took an about-face and went backwards,” said Mickey Letson, president of the Letco Companies. “Now albuterol shows a higher ASP. How that's possible I have no idea.”
Also surprising were the reimbursements for DuoNeb and Xopenex. DuoNeb will see a $1.30 per dose reimbursement. Xopenex will be reimbursed at $3.20 per dose for the .125 mg strength and $1.60 per dose for the .63 mg strength.
This pricing could attract more providers to Xopenex, which was not profitable under the average-wholesale-price reimbursement formula. Under AWP pricing the drug's reimbursement was $2.21.
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