DMERC proposal overshadows favorable Xopenex reimbursement

Sunday, June 25, 2006

WASHINGTON - Look for Medicare to increase Xopenex reimbursement dramatically in the third quarter but to keep pricing for other respiratory meds stable, according to data released by CMS last week.

Xopenex reimbursement rose 23 cents to $3.76 per dose. That increase likely reflects an average sales price that has climbed about 7% annually for the past two years, say industry watchers.

DuoNeb was down 2 cents to $1.07, and other pricing changes were similar.

However, with the DMERCs proposing to reimburse brand-name Xopenex and DuoNeb at much lower generic rates, providers should remain cautious and not bank too heavily on the new prices not changing. If the DMERCs have their way, for example, Xopenex could go from $3.76 per dose to 20 cents.

"In normal situations, I would be happy and the market would be happy with those numbers," said Mickey Letson, president of Decatur, Ala.-based Letco Companies, a wholesale drug distributor "As it is, I feel those are preliminary numbers pending the DMERC local coverage determination.

"The only thing we can extrapolate from this update is that albuterol is going to go up about 2 cents a dose (to 20 cents)," added Letson.