Nebulizer meds: Pricing up, down and all around down

WASHINGTON--The latest average sales price figures presented a mixed bag for nebulizer medication providers in June. The most significant surprise: an 86 cent drop in Dey's Perforomist, which landed at $4.08 per dose, while Sepracor's Brovana, a similar long-acting beta-agonist, rose slightly, from $4.74 to $4.79. “These two drugs are exclusively homecare drugs,” said Wayne Vega, senior vice president of sales for Harvard Drug Group. “There is no retail. Sepracor has a significant rebate program that puts that drug way below that published number.” Since the new figures include just one quarter with the new code for Perforomist, it is also surprising that the product took that much of a drop, he said. Also taking a hit: Xopenex, which saw its reimbursement cut from 70 cents to 58 cents. “Sepracor's always provided a rebate to make it break even and then the pharmacy can make money on the dispensing fee,” said provider Sam Jarczynski, president of Rx Stat in St. Petersburg, Fla. “Sepracor's going to have to amend their contract to get pricing down to where it's worth putting out.” Xopenex and DuoNeb both got a break when Medicare announced in June that it was suspending planned payment cuts for the two drugs. The agency had proposed paying for the drugs at the same rate as generics. Still, DuoNeb dropped almost 25 cents to 58 cents per dose. Budesonide moved from $5.08 to $5.34 and ipratropium held steady at 20 cents and albuterol at 10 cents. DuoNeb provider Mike Kuller, president of All Star Oxygen Services in Concord, Calif., was phasing out the last of his neb-med patients in June. “There's only 30 of them,” he said. “We're notifying them that we are getting out of the business and we'll transfer their prescriptions to their local pharmacy. We'll give them one more refill if they need it.”