Reimbursement

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Thursday, January 31, 2002

YARMOUTH, Maine - Industry observers speculating that reimbursement for respiratory medications would take a hit of up to 25% in January have been looking through a cracked crystal ball.

New fee structures released by the Region B and Region C DMERCs show no major changes to reimbursement, despite loud grumbling recently of inflated average wholesale price (AWP). But that's not to say it won't happen later this year, according to Mickey Letson, president of the Decatur, Ala.-based Letco Medical.

"Especially if there's a service fee instituted for HME," Letson said.

One significant change to the fee structures is a new code for budesonide. According to Letson, there'd been some talk that Medicare would only reimburse for unit doses of the steroid. But because the new code includes modifiers, Medicare plans to reimburse for budesonide when it's compounded with other drugs.

If that's the case, Letson expects budesonide to take the place of DuoNeb, a FDA-approved albuterol and ipratropium compound rumored to have an AWP of $2 per dose. Before DuoNeb, pharmacists could compound the two drugs , but now that a premixed version is commercially available, they're forced to purchase it. If a steroid like budesonide is added to albuterol and ipratropium, however, it's different than DuoNeb, and pharmacists can legally compound the drugs.

The new fee structures, which also include new codes for albuterol and ipratropium, went into effect Jan. 2. HME

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