Xopenex too pricey?
While the overriding question posed by Medicare in its national coverage analysis is whether certain neb meds should be reimbursed, the fact that CMS specifically mentioned levalbuterol--or Xopenex--makes it seem likely that cost is the bottom line, say insiders.
Both albuterol and Xopenex are fast-acting rescue drugs with similar onset times but while the patent for albuterol expired years ago, Xopenex is still relatively new, patent protected--and more expensive.
First quarter reimbursement for albuterol was about 16 cents per dose; Xopenex ranges from about 86 cents to $3.48. The dispensing fee--$33--is the same on both.
CMS lacks authority to change reimbursement rates, but creating stricter coverage criteria offers the agency an opportunity to reduce what it pays out, said Mickey Letson, president of Decatur, Ala.-based Letco Companies.
"We feel that probably what they are headed toward is requiring additional documentation in order to gain reimbursement for Xopenex," said Letson. "They'll make it more difficult to prescribe, until physicians say it's too much work, and they'll make it hard on providers to provide the drug."
There is limited published data demonstrating Xopenex's effectiveness over albuterol. However, studies have shown that patients treated with Xopenex required less medication, had shorter hospital stays, spent less for nebulizer therapy and hospitalization and experienced a more prolonged therapeutic benefit.
"If albuterol will meet the patient's needs, (fine), but if there is documented sensitivity, I certainly think we have a responsibility to provide Xopenex," said Kelly Riley, director of The MED Group's National Respiratory Network. "But we also have a fiduciary responsibility."