CMS delays changes to neb meds

Wednesday, January 31, 2007

WASHINGTON - CMS initiated a national coverage review Dec. 20 on the use of levalbuterol in the treatment of COPD. The move will delay any possible reimbursement cuts to nebulizer medications for at least the first half of 2007.
The industry held its collective breath for most of 2006, waiting for a final decision on reimbursement for brand-name drugs Xopenex and DuoNeb at generic rates. Reimbursement for those drugs will now be delayed until CMS releases its national coverage review.
"For this class of drugs, it was something that was worthy of a national coverage determination," said Joe Lewarski, vice president of clinical affairs for Inogen, a maker of portable oxyen concentrators. "It's a high utilization and high expense area for Medicare."
Tom Pontzius, director of VGM's Nationwide Respiratory, said studying the clinical aspect of these drugs could help justify reimbursement.
"They want clinical studies and scientific information," said Pontizus. As CMS reviews individual drugs, a chance exists, especially with levalbuterol and other newer drugs, that the evidence will not support their effectiveness and therefore affect reimbursement.
Industry watchers, however, say that Medicare should not get into the business of telling doctors what they can or can't prescribe. The physician should be able to prescribe what he feels best suits to a patient's condition, they say.