Nevada senator carries fight to CMS

Thursday, September 30, 2004

WASHINGTON - In a letter to CMS Administrator Mark McClellan, Sen. John Ensign, R-Nev., urged Medicare not to cut reimbursement for respiratory drugs and other DME products to the point that suppliers stop providing them and, in turn, beneficiaries “lose access to these critically important services.”

In his letter, sent earlier this month, Ensign called CMS’s plan to reduce reimbursement for respiratory drugs to the average sales price plus 6% “inadequate.” He explained that the “six percent add-on to the ASP would not cover the costs of providing pharmacy, compounding, patient management, delivery, billing and other ancillary services.”

Ensign added that “he applauds” CMS’s recognition of the need for a separate dispensing fee to compensate providers for services and other administrative services they provide. However, the fee must be “meaningful” and reflect a provider’s actual costs, Ensign stated.

In his letter, the senator also “encouraged” CMS to consider cost differences between Medicare and the Federal Employee Health Benefit Program before making any reimbursement cuts based on the FEHBP.

“Factors such as age, health status, claims processing and documentation requirements, along with the suppliers’ cost of doing business with Medicare compared to FEHBP plans, would seem to be issues that CMS should weight carefully,” Ensign wrote.