ASP pricing could limit patient choice

Saturday, January 31, 2009

BALTIMORE –With payments for nebulizer medications about as low as providers can withstand, patients could see fewer treatment choices, say industry stakeholders.

“There’s a limit to what products providers will supply,” said Mickey Letson, president of Decatur, Ala.-based Letco Companies.

For the latest average sales price (ASP) figures, released in mid-December, albuterol (J7613) and ipratropium (J7644) were unchanged at 11 cents and 21 cents respectively. Budesonide (J7626) enjoyed the biggest increase: up 24 cents to $5.63.

Xopenex (J7614) reversed a steady decline, rising 7 cents to 60 cents per dose - still a far cry from $3.84 in early 2007. Many providers have stopped filling scripts for the drug, and beneficiaries are feeling the effect, said Letson.

“I spoke with Medicare (in December) and I was told they are getting letters from beneficiaries asking why Xopenex is not available,” he said. “Reimbursement is well below providers’ cost.”

Provider David McDonald offers Xopenex to patients when Medicaid or private insurance will pay for it, but not for Medicare. Still, he won’t sound the death knell for Xopenex just yet.

“My gut feeling is Xopenex will see life again,” said McDonald, president of Texarkana, Texas-based Senior Respiratory Solutions. “The efficacy of the drug, as well as the physicians and people I’ve spoken with, (makes me think) that Medicare is going to re-look at (pricing).”

Brovana dropped 4 cents to $4.95. Many providers have begun offering the drug more - but only for patients who can afford co-pays of $70 to $80, said Letson.

“There’s not enough profitability from paying patients to absorb the non-paying patients,” he said. “It’s been cut to the level that the providers can’t continue to do it, and pay shipping and operating costs and provide the full range of drugs.”