Medicare keeps respiratory drug pricing stable

Sunday, March 27, 2005

March 28, 2005

BALTIMORE - Sepracor’s respiratory drug Xopenex again saw the upshot of the new ASP drug reimbursement with a 34 cent boost under CMS’s second-quarter Part B drug fees released earlier this month - the only significant change in the new pricing, said industry sources.
“Xopenex continues to be a big surprise, and we are happy with that because there were so many years that we provided it with really no reimbursement and patients struggled to get it,” said Harold Davis, director of operations for VGM’s Nationwide Respiratory. 
Xopenex will be reimbursed at $3.54 per dose, up from $3.20 per dose during the first quarter.
Albuterol’s reimbursement also saw a boost in price from 18 cents to 23 cents a dose for the second quarter. In contrast, ipratropium bromide’s reimbursement fell three cents to about 10 cents a dose.
“It was nice to see them move albuterol up a couple cents,” said Davis. “It doesn’t sound like a whole lot, but we do a significant amount of albuterol, so the volume helps it a lot.”
The relative stability of the second-quarter fee schedule was a relief for some in the industry who feared that CMS might crack down on increasing utilization of drugs like Xopenex and DuoNeb based on their higher price points. Lisa Smith, an attorney with Brown and Fortunato, however, said she has seen no indication from CMS that such a change is being considered.
DuoNeb and Xopenex were expected to see increased utilization as some providers look to find profitable drug mixes for their patients. Others, like Respiratory Distributor’s president Ketih Trowbridge are encouraging a more conservative approach.
“It’s still too early and things are still going to jump around until all the kinks are worked out,” said Trowbridge. “Just do what you are doing because what you were doing is probably right. I have recommended no major changes at this point and will probably continue on that posture until summer when I see another quarter’s worth of data.”
The Medicare Modernization Act mandated that Part B drugs be reimbursed based on the manufacturer’s average sales prices and that those prices be updatde quarterly. The second-quarter fee schedule will be effective April 1 through June 30 and is based on manufacturer data from the fourth quarter of 2004.