Respiratory Drug Fee Schedule Reflects New Utilization Trends

BALTIMORE–Budesonide is up, ipatropium is down and albuterol is
back at its first-quarter levels in CMS’ newly released
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 ballgame 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 six percent. Late
last year, the government announced a $57 monthly and $80 quarterly
dispensing fee to compensate for expenses connected to providing
the drugs.

There was some confusion when CMS posted the quarterly fee
schedule update with an error for the albuterol compound solution
(DuoNeb). The agency has since revised the price for that drug to
$2.36.

For more information, visit Medicare’s Part B Drugs ASP Web site
by clicking
here.