Government Launches Inhalation Drug Service Survey

WASHINGTON–HHS’ Office of Inspector General has begun surveying
providers to help determine the costs of inhalation drug therapy
services. The results could be significant, according to the
American Association of Homecare, because they may factor into
future decisions about Medicare’s Part B inhalation drug dispensing
fees.

That fact concerns the association because it says the survey is
not thorough enough and could lead to some inaccurate
conclusions.

Earlier this month, the OIG sent the survey to a random sample
of inhalation drug therapy providers, requesting that they complete
a form for each service they provided in 2003. According to
AAHomecare, not all dispensing fee service categories–after-hours
and weekend services, for example–are listed on the questionnaire.
Providers will have to complete additional pages on these unlisted
services.

“It is critical that you capture and record all services
provided to and contact made with the identified patients in order
to provide support for the extensive costs incurred by pharmacies
in dispensing inhalation drugs to Medicare beneficiaries,”
AAHomecare advised providers in a mid-week bulletin.

The organization said it has requested a meeting with the OIG to
discuss its concerns about the accuracy of the survey.

Responses are due on Wednesday, but AAHomecare is asking that
providers request a deadline extension to June 20, which would
allow time for responding companies to gather the necessary
documentation.

Last year, the association commissioned a study of 109
pharmacies and found that the Medicare 2005 reimbursement
formula–based on average sales price plus 6 percent–would
under-reimburse the actual cost of providing and dispensing
albuterol sulfate and ipratropium bromide by $68.10 per monthly
supply. And after some of the nation’s largest providers–including
Apria and Lincare–threatened to leave the respiratory drug
business without adequate reimbursement, CMS announced in November
it would add a $57 monthly or $80 quarterly dispensing fee for
inhalation drugs in the 2005 fee schedule.

Since the new reimbursement formula took effect Jan. 1, there
have been some glitches with claims for the dispensing fee. Last
month, Lincare and other providers reported having dispensing fees
denied during the five-day grace period that allows time for
patients to receive refills before their prescriptions run out at
the end of the billing cycle.

Some also have had dispensing-fee trouble for patients who get
medication from more than one pharmacy. Only the pharmacy that
bills Medicare first within the 30- or 90-day cycle receives the
dispensing fee.

Medicare policy for the new dispensing fee states “per patient
per month–not per provider,” said Mickey Letson, president of drug
wholesaler The Letco Cos., Decatur, Ala. “It’s first come, first
serve,” he said, “and that has created problems for a few.”