Respiratory Drug Schedule Reflects New Trends

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Budesonide is up, ipatropium is down and albuterol is back at its first-quarter levels in CMS’ third-quarter pricing for respiratory drugs.

The latest respiratory drug fee schedule reflects new utilization trends, showing that since Xopenex has become reimbursable, it is quickly becoming the most popular respiratory drug, said Harold Davis, COO for Conway, Ark.-based Baker Medical and a respiratory specialist for Nationwide Respiratory, a division of VGM. “The trend is shifting to that drug away from albuterol and ipratropium,” he noted. “You’re seeing albuterol stay pretty flat, and ipatropium is continuing to drop.

“It’s a whole different ball-game since last year,” Davis continued. “I think we’re going to continue to see these fluctuations in reimbursement. Some quarters are going to go up and some are going to go down.” Overall, Davis said he believes the changing fee schedule will have little effect on providers’ bottom lines because pricing is based on the actual costs of the drugs.

The Medicare Modernization Act moved respiratory drug reimbursement away from an average wholesale price (AWP) system to a formula based on average sales price (ASP) plus 6 percent.

Late last year, the government announced $57 monthly and $80 quarterly dispensing fees to compensate for expenses connected to providing the drugs.