CMS Finalizing Medicare Average Sales Price Proposed Rule
This article was originally published in The Pink Sheet Daily
Executive Summary
CMS hopes to issue the ASP+6% rule July 27. The agency wants to ensure that stakeholders have plenty of time to respond to the new reimbursement formula. Oncologists plan to make the case that payment cuts are too steep.
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The Centers for Medicare & Medicaid Services is planning to release the proposed rule implementing average sales price-based reimbursement under Medicare Part B on July 27. The proposed rule will offer the first indication of how "average sales price" compares to "average wholesaler price" for physician-administered drugs under Part B. CMS released an interim final rule defining "average sales price" in April and began collecting reports from manufacturers (1 (Also see "Average Sales Price Formula Closely Follows Medicare Rx Law" - Pink Sheet, 1 Apr, 2004.)). Under the Medicare Rx law, Part B drug reimbursement will shift from an average wholesale price-based model to the new ASP formula in January 2005. As with all of the Medicare Rx implementing regulations, the timing of the release of the ASP rule is still subject to change. However, CMS wants to issue the physician payment rule as soon as possible to allow adequate time for stakeholder debate. Provider groups, and particularly oncologists, argue that the combined impact of the new reimbursement plan and changes to administrative payments scheduled for 2005 will cause significant harm to medical practices (2 (Also see "ASCO Targets Tax Bill For Reimbursement Changes; Goal Is Maintaining 2004 Payments" - Pink Sheet, 7 Jun, 2004.)). Practitioners cannot flesh out their arguments about the economic impact of the changes until the proposed rule comes out and provides actual values for the ASP-based payment. - Kate Rawson |