Medicare Permits Separate Vaccine Billing For Product, Administration
CMS will allow Part D vaccine administration to be billed and reimbursed separately from product costs in 2008, the agency states in guidance to Medicare drug plan sponsors issued May 14
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Proposal, which could be formally endorsed by MedPac this spring, would lower the payment rates for vaccines while simultaneously moving all preventative vaccine coverage to Medicare Part B. Commission signals further cuts to payment rate, through an average sales priced-based methodology that might eventually be recommended.
GSK’s blockbuster Shingrix and other Part D vaccines would be switched to Part B under proposal being developed by influential advisory commission. Lack of pricing controls in Part B is generating concerns among panelists, though, as MedPAC aims to finalize its recommendations on revising Medicare reimbursement for vaccines by next spring.
US FDA’s first decision on biosimilars interchangeability might have less meaning for two insulin products, but payer and prescriber responses to interchangeable biosimilars for adalimumab, which are further out on the horizon, may be more instructive regarding the importance of interchangeability status.