Medicare Reimbursement for Xopenex Soars

BALTIMORE–Respiratory drug providers found that Medicare fees
for Xopenex will shoot up 33 cents a dose, as CMS released its
second-quarter Part B drug fees last Friday.

The fee hike, which ups the price per dosage to $3.53, will
bring providers roughly $40 more per patient per month, according
to Mickey Letson, president of drug distributor The Letco
Companies, Decatur, Ala. “This [represents] a huge pendulum swing
for that drug in the minds of people in the marketplace,” he said,
adding that, if the government continues to use its current
calculation methods, “there appears to be a chance it could go up
even more.”

Per the Medicare Modernization Act, Part B drugs fees must be
based on the average sales price plus 6 percent, updated quarterly.
The recently released fees will be effective from April 1 through
June 30, and are based on average sales prices for the drugs during
the fourth quarter of 2004.

Albuterol fees for the second quarter will increase from 7 cents
to 9 cents per milligram, and ipratropium fees will go down from 29
cents to 20.2 cents per milligram, according to the fee
schedule.

“Nothing ended up at what people thought it would be,” Letson
concluded, adding that this year’s third and fourth quarter pricing
updates–based on average prices from 2005’s first and second
quarters, respectively–“will start to tell you the buying habits
of DME providers this year.”

The latest fee schedule is posted on the CMS Web site, available
by clicking
here.