Baltimore
In early November, Medicare announced $57 monthly and $80
quarterly dispensing fees for inhalation medications in 2005,
erasing much uncertainty within the home respiratory industry about
the reimbursement climate for inhalation therapies next year.
“We view this as a transitional fee,” said CMS
Administrator Mark McClellan during a press briefing. Due to the
broad range of dispensing fees the agency reviewed, he explained,
CMS plans to re-evaluate the cost of dispensing the medications
next year. “In the coming year, we'll gather more data on
whether care is affected under the new payment schedule,” he
said.
The fee was announced as part of the Medicare 2005 Physician Fee
Schedule. McClellan said the schedule represents an overall
spending increase of 4 percent, from $53.1 billion in 2004 to $55.3
billion in 2005.
The schedule referenced an October General Ac-countability
Office report that found the cost of dispensing inhalation drugs
ranged from $7 to $204 among 12 suppliers surveyed.
CMS indicated that the wide range is due in part to the range of
supplier services, some of which “may not be necessary to
dispense inhalation drugs,” including marketing, overnight
shipping and a 24-hour hotline to answer beneficiary questions.
McClellan said CMS based the 2005 fee on an August study
commissioned by the American Association for Homecare that named a
$68.10 dispensing fee. The study broke costs down into a number of
components, some of which CMS' health policy analysts thought
should be incorporated into the final fee, he explained. In
addition, CMS has indicated that the physician will determine
whether a beneficiary requires a 30-day or 90-day supply of the
drugs.
Among other specifics, the rule:
Explains that the fee “covers all drugs shipped to a
beneficiary during a month (or 90-day period) regardless of the
number of times a supplier ships inhalation drugs to a
beneficiary,” and that “a per-dose dispensing fee could
provide an incentive to supply more drugs.”
Bundles drug compounding into the dispensing fee, eliminating
the modifier to bill for compounding separately. “The costs
of compounding are included in the AAH study but are not separately
identified in the direct cost line items,” the rule stated.
“Because the 2005 fee is based on the AAH study, we need to
avoid duplicate payment.”
Requires only a verbal order for dispensing respiratory drugs,
but does require a written order for billing.
As required by MMA, reimbursements for inhalation drugs in 2005
will be based on Average Sales Price plus 6 percent.
Final respiratory drug fees for the first quarter of 2005,
expected to be announced this month, will be based on third-quarter
ASP data, CMS said. adding that second-quarter ASP data showed
average price increases for both albuterol and ipratropium.
