Prices, audits stay the course

Monday, April 23, 2012

BALTIMORE – Brand-name Brovana took a hit in the latest average sales price (ASP) figures for nebulizer medications, but otherwise there were few major changes.

The long-acting beta agonist Brovana (J7605) decreased 24 cents to $5.11 per dose in the latest figures, released in March. 

Between the lower reimbursement and a price increase from the manufacturer, you won’t see many providers supplying the drug, said Sam Jarczynski, who blames market consolidation for the change.

“There are so few respiratory pharmacies doing the business, that when somebody big like Apria or Lincare is buying the majority (of the drug), that reduces the ASP for everybody,” said Jarczynski, president of RxStat in St. Petersburg, Fla.

The other long-acting brand name drug, Perforomist (J7606), is up 18 cents to $5.02 per dose. Also getting a boost: budesonide (J6726), which increased 32 cents to $4.96 cents per dose.

All three of these “high ticket” drugs remain vulnerable to audits, say industry sources.

“It’s been a steady volume,” said Jarczynski. “A lot of times they blanket deny it, but we are getting paid 99% of the time on appeals.” 

In cases where providers aren’t getting paid, it’s often a technicality, says Wayne Vega, senior executive vice president of the Inhalation Drug Group. The chart notes need to show continued use and need, and the correct drugs must be documented, he said. For example, a physician may prescribe DuoNeb, but the specialty pharmacist recommends a combination of Perforomist and budesonide.

“The physician says that’s a great idea and switches them,” said Vega. “The pharmacist dispenses the Perforomist and budesonide and they get all their documentation, and the physician still has DuoNeb in their chart because no one changed it.”

Other neb prices were as follows: albuterol (J7613) and ipratropium (J7644) were relatively flat at just over 15 cents and 13 cents per dose respectively; levalbuterol (J7614) was up 8 cents to 72 cents per dose; and DuoNeb (J7620) was up almost two cents to 30 cents per dose.