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Plasma Group To Seek Legislation On IVIG Access As CMS Cuts Preadmin Fee

Executive Summary

The Alliance for Plasma Therapies will begin working on convincing Congress that legislation is needed to ensure access to intravenous immune globulin therapies now that the preadministration fee in Medicare Part B has been dropped

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IVIG Access Issues Highlighted In Effort To Eliminate Specialty Drug Tiers

Continued problems with patient access to intravenous immune globulin therapies is helping patient advocacy groups put the spotlight on payers' handling of IVIG on their formularies and make a push for eliminating the use of specialty drug tiers

IVIG Access Issues Highlighted In Effort To Eliminate Specialty Drug Tiers

Continued problems with patient access to intravenous immune globulin therapies is helping patient advocacy groups put the spotlight on payers' handling of IVIG on their formularies and make a push for eliminating the use of specialty drug tiers

IVIG legislation reintroduced

Legislation regarding the reimbursement rates for intravenous immune globulin therapies has been reintroduced by Sens. John Kerry, D-Mass., and Lamar Alexander, R-Tenn., though this bill is different from a previous effort in that it does not call for the continuation of a pre-administration fee that has been used by physician offices and hospital outpatient centers to cover the cost of IVIG therapies (1"The Pink Sheet," May 12, 2008, p. 32). Instead, the latest version of the legislation, known as "The Medicare Patient IVIG Act," S. 701, directs the HHS secretary to collect data on the costs incurred to obtain IVIG therapies and the amount that is reimbursed, as well as providing the authority over a two-year window to adjust payments as necessary to avoid any access issues. IVIG is reimbursed like other Medicare Part B drugs using an average sales price-based rate for each of the six IVIG products available (ASP+6% in the physician office and ASP+4% in the hospital outpatient setting). Advocacy groups have argued that access to IVIG has suffered from low reimbursement. CMS dropped the pre-administration fee beginning in 2009 (2"The Pink Sheet," Nov. 17, 2008, p. 21)

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