Medicare ESRD Payment Should Account For Epogen Price Increase, Dialysis Centers Say
This article was originally published in The Pink Sheet Daily
Dialysis centers write to CMS saying that upcoming Medicare payment cuts for end-stage renal disease treatment, combined with a 5% Epogen price increase, will put “additional pressure on already thin Medicare margins.”
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In legislation passed by both chambers of Congress Jan. 1, the cost of a one-year reprieve from sharp cuts to Medicare physician payments, scheduled to begin in 2013, would be offset by a reduction in Medicare’s bundled payment for end-stage renal disease. The reduced payment would take into account a drop in the use of erythropoiesis-stimulating agents observed over the last several years.
A Government Accountability Office report finds that use of erthryopoiesis-stimulating agents in dialysis decreased 31% from 2007 to the end of 2011 after Medicare’s bundled dialysis payment was changed to include drugs and FDA revised dosing recommendations.
Heavily rebated drugs may already be meeting the price goals established by the Senate legislation. As a result, price negotiation for drugs covered under Part B are likely to yield greater savings to the Medicare program than Part D.