Medicare Payment Cuts For Vaccines: MedPac Suggests Moving To New WAC-Reimbursement Formula
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.
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That sound you hear is the staff of the US Medicare Payment Advisory Commission digging into new sources of data about the impact of rebates on the Part D outpatient drug benefit. Expect new policy ideas to follow – though not right away.
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.
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