Neb-Med dispensing fee spurs confusion

Sunday, November 14, 2004

November 15, 2004

WASHINGTON - CMS said Friday that the new $57 dispensing fee for respiratory medications, established in the Federal Register earlier this month, would be paid per-patient per-month.
This ruling flies in the face of some reports and rumors that the fee would be administered per-drug per-month, a set-up far more favorable for respiratory providers.
One thing is for sure: “There’s a lot of confusion still remaining,” said one financial analyst.
Under 2004 rules, when a provider shipped a 30-day supply of albuterol, they got $5. But, if they shipped both a month’s supply of both albuterol and ipratropium they got paid two $5 dispensing fees.
"I talked to some people who might try to exploit that in 2005, but I have talked to companies who seem pretty adamant that CMS is going to close that loophole,” said the analyst.
Questions surrounding the adjudication of the fee arose after the Final Rule with comment period was posted to the Federal Register on Nov, 3. Wording in the rule itself and in the included comment section was ambiguous and left the payment method open to interpretation.
A CMS official, however, confirmed last week that it would be paid as a monthly fee per-patient. Some providers, however, argue that this method is unreasonable because it does not take into account the additional shipping and labor costs accrued when dispensing multiple drugs.