ASP: Winners, losers, audits

BALTIMORE - With few exceptions, the average sales price (ASP) figures for nebulizer medications don't change much from quarter to quarter. That doesn't mean the market is stagnant, says Wayne Vega, senior vice president of the Inhalation Drug Group. He recently offered HME News his take on the fourth quarter numbers—and the market.

Winners

Budesonide (J7626) increased 85 cents, to $5.95 per dose. The entry of another generic version of the drug into the market earlier this year didn't have the expected impact of lowering the ASP, said Vega.

Brand-name drugs Brovana (J7605) and Perforomist (J7606) continue to do well, with increases of 20 cents and nearly 39 cents per dose, respectively. Not only does Vega not see that changing, he anticipates the entry of additional, high-ticket brand name drugs into the market in 2014.

“That will be a benefit to the homecare pharmacies,” he said.

Losers

Albuterol (J7613) slid a penny to 12 cents per dose, which Vega attributes to the “self-defeating” cycle of ASP, in which the better the purchasing prices the pharmacies can get, the lower the ASP gets until the reimbursement is lower than what they can buy it for.

“Eventually, the manufacturers will say 'no more discounting' of drugs,” said Vega. “I anticipate we'll see manufacturers start to raise prices, and the pharmacies will buy it at a loss until the ASP starts creeping back up.”

Audits

As with many other segments of the HME industry, neb-med providers are getting slammed with pre-pay audits, mainly targeting the brand-name drugs. The resulting cash-flow crunch—it can take 120 days to get paid—makes it very difficult to provide certain drugs, said Vega.

“Everybody is victim to Medicare's infinite wisdom that if you provide a high-ticket item, you are therefore doing something wrong,” he said. “There's really no basis for these audits.”