Neb-med providers wonder what's next

Thursday, January 31, 2008

YARMOUTH, Maine -There weren't too many surprises in the latest average sales price figures for respiratory medications, but providers were scratching their heads all the same.
The biggest change came in DuoNeb, which dropped 27 cents to 81 cents per dose.
"I don't see how CMS could lower the price so quickly," said Sam Jarczynski, president of RxStat in St. Petersburg, Fla. "They haven't sold anything."
With several new generics hitting the market in January, providers will have to wait and see if the pricing drops further.
Another change: Albuterol and Xopenex received a new code, J7603. Since July both drugs had been bundled under a temporary code (See HME News, July 2007). The reimbursement was up slightly, rising from $1.05 to $1.11, but the agency plans to modify how it pays for the two drugs (See related story, page 1).
Starting April 1, the ASP for albuterol will be calculated by itself, while the ASP for brand-name Xopenex will be calculated with albuterol.
"That will probably leave Xopenex where it is but drop albuterol back to the 20-cent range," said Mickey Letson, president of Decatur, Ala-based Letco Companies.
Also getting a new code in January was Sepracor's new long-acting drug, Brovana, J7605, with a reimbursement of $4.72, a drop of 17 cents. What remains unclear is whether Perforomist, currently billed under a miscellaneous code, will eventually be billed under J7605 as well. Both drugs are long-acting bronchodilators prescribed for twice-daily use, but Perforomist, which launched in October, didn't get FDA approval in time to get a code for 2008.
"In theory, they should have combined those two," said Letson. "But, the actual rule states this only applies to drugs approved by a certain date."