Report 'rehashes' savings proposal

Tuesday, May 26, 2015

WASHINGTON – A recent report from the Office of Inspector General that says CMS overpays for infusion drugs isn’t all that different from a similar report in 2013, say infusion stakeholders.

“It’s a rehash and, based on the timing, it was probably a result of the drugs not being included in Round 1 2017,” said Bill Noyes, vice president of health information policy for the National Home Infusion Association.

The report, released in April, said CMS could have saved $251 million over an 18-month period if it had paid for DME infusion drugs using an average sales price methodology instead of an average sales price model. The OIG recommended that CMS either seek a legislative change requiring infusion drugs to be paid using ASP, or include the drugs in the next round of competitive bidding.

“We understand where they are at when looking at (costs),” said Kendall van Pool, vice president of legislative affairs for NHIA. “However, it’s important to remember we are still in a similar scenario with these Part B drugs, in that the services component of the payment is missing.”

Although CMS concurred with the competitive bidding recommendation, stakeholders say the agency should look to lessons learned in the Round 1 re-compete, in which it bid infusion pumps and supplies, before making any changes.

“I think they saw that the savings were a lot less than in other product categories,” said Noyes.

That’s likely due to a combination of higher average payment rates and a lower sales volume compared to other product categories, he surmised.

Infusion has not been included in any subsequent rounds of bidding.

NHIA plans to use the report to back its efforts to get a pair of bills that seek to establish a comprehensive Medicare benefit for home infusion therapy passed. The bills were introduced in both the House of Representatives and the Senate on Jan. 28. The bills currently have 17 and 12 co-sponsors, respectively.

“We continue to hear on Capitol Hill, ‘right care, right place, right time,’” said van Pool. “That is what we do, and when we talk to staffers, it becomes very real in the context of everything else they are talking about.”