CMS: Part D will promote MDIs

WASHINGTON - CMS is setting itself up for a “substantial shift” in the respiratory market in the near future - and one that is not a result of the contentious average sales price reimbursement. When the Part D drug benefit begins in 2006, Medicare anticipates that the coverage of meter dose inhalers will send the popular nebulizers therapies packing. “Since Medicare currently covers inhalation drugs provided through nebulizers, but not alternatives forms of inhalation therapy, there are strong financial incentives toward the use of the [nebulizers],” stated a Notice of Proposed Rulemaking issued by CMS in July. “It would not be unlikely for many beneficiaries to choose the convenience of MDIs over nebulizers once the Medicare coverage imbalance is removed in 2006.” Industry players rebuff this assumption. “I don't believe it for a second,” said Mickey Letson, president of The Letco Companies. “They are claiming that there is no difference between [MDIs and nebulizer] or that the only reason there is a difference is because Medicare don't pay for MDIs. I doesn't buy that for a minute.” Respiratory providers have for years touted the differences between the two treatment options. A major argument is that nebulizers provide a more effective treatment for many people who may not have the dexterity to operate a small inhaler. “I've seen a lot of these patients, and they don't do it,” said Letson. “The studies [CMS] keeps referencing about the therapeutic benefit is true if you have a 35-year-old male who is well coordinated. It's not true for 65-and-older COPD patients.” In the notice, Medicare refutes such claims saying there are options, like spacers and holding chambers, that ensure proper inhalation when using MDIs. The agency also points to the dexterity requires to maintain, operate and clean a nebulizer correctly. Until the drug coverage goes into effect in 2006, beneficiaries will only get a 25% discount on MDIs through the discount drug card program. Although the savings are helpful, nebulizer co-pays will also see a reduction when the reimbursement for albuterol and ipratropium is cut in 2005. “The 90% cuts mean that the patients 20% co-pay is going down too. It is still going to be cheaper to pay for the nebulizer than an MDI even with the discount card,” said one industry source. “It's a red herring.”