Neb-med pricing parked in neutral

Thursday, April 30, 2009

YARMOUTH, Maine--After several quarters of wild price swings, the latest average sales price (ASP) figures for nebulizer medications barely stirred when they were released in March.

“There were no surprises,” said Wayne Vega, senior vice president of sales for Harvard Drug Group. “I think we are really seeing the spirit and intent of the Medicare Modernization Act, which is that reimbursement for the drugs should be cost plus 6%.”

Reimbursements changed only slightly from the previous quarter, if at all. Albuterol (J7613) was up a penny to 12 cents per dose and levalbuterol (J7614) increased 4 cents to 64 cents. Ipratropium (J7644) remained at 21 cents per dose and Budesonide (J7626) at $5.63.

The biggest drop was for the relatively new Brovana (J7605), which slid 14 cents to $4.81.

“They are still adjusting the ASP on that one,” said provider Sam Jarczynski, president of St. Petersburg, Fla.-based Rx Stat. “As more people start to prescribe it and usage goes up, the price comes down.”

Also in March, National Government Services, the Jurisdiction B DME MAC, clarified coverage criteria for switching patients from short-acting to long-acting COPD drugs. Patients must have a documented three-month history of using albuterol at least four times a day; or levalbuterol at least three times a day. Previously, providers just needed to show that the patient had tried and failed - there was no specific timetable.

That will mean change for providers like Jarczynski. He dispenses short-acting drugs like albuterol for a month before transitioning patients to something else.

“Patients are not compliant when they have to take something four times a day,” he said. “Why not start them right off on the right drug?”

Long-acting drugs are already the drug of choice, said Vega. He predicts the three-month requirement will eventually change.

“We’ll look back in a year or two and say, ‘Wasn’t it silly to have to have the patient do the short-acting before the long-acting drug?’” he said.