Penn. infusion providers face reimbursement cuts
HARRISBURG, Pa. - Infusion providers in Pennsylvania are taking a turn at the chopping block. In August, the state cut reimbursement for brand-name and generic drugs, including many staple infusion mixtures.
The state's Department of Public Welfare revised the payment for pharmaceuticals, effective Aug. 29, 2005, from the average sales price plus 6% to wholesale acquisition cost plus 7% for brand drugs and WAC plus 66% for generics, according to Dave Fiorini, executive director of the Pennsylvania Association of Medical Suppliers.
The state argues that the cut is necessary because its payment rates are higher than other payers in Pennsylvania and many comparable state Medicaid programs.
The problem, say providers, is that WAC pricing is often below what the infusion provider's acquisition costs.
"In some instances, it's not even how much I'll make, but how much I am going to lose," said Helen Michener, general manager of Critical Care Systems in Harrisburg, Pa.
"There is no way to get all the services that go into infusion drugs really covered any other way than through the per diem and some of the drug cost," she added. "So when you are just barely covering the cost of the drug, providers are going to start refusing patients. It's going to limit access, and patients are going to end up in hospitals when they don't need to be."
PAMS is working with infusion providers to try and remedy the situation. Fiorini said the best fix would be to re-categorize infusion pharmacies as separate entities from standard retail pharmacies.
The association is trying to get state legislators to visit home infusion facilities so they can see how different the two businesses really are.
"We are fighting to get legislators to see that even though we are a retail pharmacy in the purest sense, that we do not function or have the same level of service to the customers," said Michener. "They are amazed when they see what is involved."