Epogen Use Re-Calculation Drives 9.4% Medicare ESRD Bundled Payment Cut In 2014
This article was originally published in The Pink Sheet Daily
CMS was directed by the American Taxpayer Relief Act to “rebase” the ESRD payment level by re-calculating the use of erythropoiesis-stimulating agents and other infused or injectable therapies.
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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.
With price controls in Medicare looming nine years after approval, launch strategies such as ‘bridge’ programs that build initial volume with free drug may have to be adjusted.