ASP pricing contains some pleasant surprises

Sunday, December 19, 2004

December 20, 2004

WASHINGTON - The ASP pricing for inhalation medications released by CMS last week included some surprises for the industry with several of the price points diverging drastically from original calculations.
One surprise was the increase in 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 shocking was the revelation that Xopenex will be reimbursed at $3.20 per dose for the .125 mg strength; $1.60 per dose for the .63 mg strength; and 80 cents per dose for .31 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 is $2.21.
“This may bode well for Sepracor,” said one source. “They may have finally gotten their drug into the market.”
The company, however, is advising providers to take this news with a grain of salt, said Letson. The DMERCs still have the final word, and they could reclassify the drug as the least costly alternative in the middle of the quarter.