Neb-meds: Budesonide plunges, bill could provide relief

Thursday, March 24, 2011

BALTIMORE - One quarter you're up, the next quarter you're down, at least if you're a provider who dispenses the nebulizer drug budesonide.

Budesonide (J7626) plunged 77 cents to $4.15 per dose in the latest average sales price (ASP) figures released March 17. Last quarter, reimbursement for budesonide had gone up 64 cents per dose, reversing a pattern of decline. A year ago, the drug was at $6.42 per dose.

"At $4.15 a dose, I am losing more than 10 cents per dose," said David McDonald, president of Texarkana, Texas-based Senior Respiratory. "But we have gone through so many of these (reimbursement) changes that we are pretty confident we'll (manage)."

Other pricing stayed relatively steady: Albuterol (J7613) was up just over a penny to 16 cents per dose; ipratropium (J7644) was flat at 13 cents per dose; Brovana (J7605) was down 2.5 cents to $5.29 cents per dose; and Perforomist (J7606) was up 7 cents to $4.70 per dose.

A new bill, if passed, could change the way ASP figures are calculated and provide some relief. Introduced on March 3 by Rep. Ed Whitefield, R-Ky., H.R. 905 seeks to exclude prompt-pay discounts from being calculated into the ASP. The discounts are typically extended from drug manufacturers to drug wholesalers.

"In theory, that could have the effect of raising the ASP," said Lisa Smith, an attorney with Amarillo, Texas-based Brown & Fortunato. "How significant that will be, I have no idea."

Amidst all of this, provider Sam Jarczynski has found himself with a new complication when it comes to dispensing certain neb-meds: audits.

"Any time I dispense a three-month supply of budesonide, Brovana or Perforomist, we get a pre-pay audit on it," said Jarczynski, president of St. Petersburg, Fla.-based RxStat. "We are having to dispense one-month supplies because the pre-pay audits are so burdensome."

That costs him more money, from an administrative and shipping perspective, he says.

Jarczynski says he's getting unfairly looped into "the whole Miami fraud fiasco." A report released by the Office of Inspector General (OIG) earlier this year found that during 2008 and the first half of 2009, South Florida providers billed Medicare for more than 7 million units of Brovana, far more than the 750,000 units drug companies sold in the region. The OIG also looked at claims for budesonide, using an edit to detect excessive claims.

"We are several hours away, but because we are in Florida, everything we do, they assume it's fraud," said Jarczynski.