Providers threaten neb-med changes

Thursday, October 28, 2010

BALTIMORE - As of Oct. 1, provider Sam Jarczynski no longer planned to dispense budesonide.

That's because the latest average sales price figures, released on Sept. 20, showed a drop for the nebulizer medication of 56 cents, from $4.85 to $4.29. That's on top of the previous drop: $1.57.

"We were breaking even on it, but now it's substantially lower than what our cost is on the drug," said Jarczynski, president of St. Petersburg, Fla.-based RxStat. "There's no way it can be dispensed to the Medicare population."

Other pricing was as follows: albuterol (J7613), 14 cents per dose; DuoNeb (J7620) .225 cents per dose; Brovana (J7605), $5.19 per dose; and Perforomist (J7606), $4.70 per dose.

Provider Dave McDonald at press time was still mulling whether to continue providing budesonide

"We are going to lose money and that's the truth," said McDonald, president of Texarkana, Texas-based Senior Respiratory. "It's going to be tough for anybody in the country to provide it."

One factor behind the drop in pricing: Budesonide is also widely used in the pediatric market, where the dose is smaller--0.25 milligrams compared to 0.5 milligrams for adults. The weighted average drags down the overall price, said one industry insider.

It's Medicare beneficiaries who will be most hurt by the change, say providers.

"When budesonide first came out we had COPDers that would never get out of their recliners," he said. "Once they took the budesonide they were able to get up and move around. If you have to pull it off the market, it's going to affect a lot of people."

Both McDonald and Jarczynski have their fingers crossed that a competing generic version of budesonide--expected sometime in December--will offer some relief down the road.

"Typically if you look at any launch of a significant generic, there should be another approximately 30% drop in cost," said McDonald. "Until then, I think it's going to be six to nine months of reduced access to care for beneficiaries."