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.
HIV community is pushing back against the change, arguing that revenue lost from reduced reimbursement will cripple providers, which use the extra funds for wrap-around patient support and services.