Medicare dispenses few changes

BALTIMORE--Reimbursement for nebulizer medications will stay about the same for the third quarter of 2009, giving providers a chance to catch their breath.

The latest average sales price (ASP) figures, released in June, put albuterol (J7613) at 13 cents per dose, up 1 cent from the second quarter; and ipratroprium (J7644) at 20 cents per dose, down 1 cent.

“When we can see six or nine months ahead, that's a wonderful thing,” said provider Dave McDonald, president/owner of Senior Respiratory Solutions in Texarkana, Texas. “It makes our lives easier. We take the dispensing fee and provide excellent service.”

One surprise: Generic DuoNeb (J7620) was up 1 cent, to 25 cents per dose.

“I anticipated that would drop,” said Wayne Vega, vice president of sales for Harvard Drug Group. “But the main manufacturers of generic DuoNeb haven't been as aggressive in the past as they are now (with pricing). Now they are getting low, low pricing out there, and we'll see the impact (on future ASP figures) possibly next quarter or the one after that.”

The ASP for Brovana (J7605) and Perforomist (J7606) remained high, at $5.08 and $4.38 per dose, respectively. With the two competing long-acting drugs so close in price, some industry watchers worry about a price war and a subsequent drop in ASP.

“The flip side - if the ASP stays so high, a lot of pharmacies are reluctant to go to it,” said Chuck Makarov, president/CEO of Letco. “The co-pay on a $5 per dose drug is higher than the co-pay on a 20 cent per dose drug. If they have somebody that doesn't pay, it doesn't take much to lose money.”

But steady ASP figures don't necessarily mean there's a lot of profit to be made on neb-meds. The $33 dispensing fee barely covers the cost of doing business, points out provider Sam Jarczynski, president of St. Petersburg, Fla.-based RxStat.

“This is strictly a dispensing fee business,” he said. “Our shipping brings in an additional $8 and billing and paperwork processes another $10, but when you add in the cost of the shipping box and the pharmacist's time, it's a skinny margin.”