Medicare IVIG Payment Study, Short-Term Fix Proposed By Sen. Kerry
Executive Summary
Sen. John Kerry, D-Mass., is bringing Medicare reimbursement for intravenous immune globulin therapies back into the spotlight, with legislation he hopes might be attached to an eventual Medicare physician payment package
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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)
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)
CMS Proposes Dropping IVIG Preadministration Fee In 2009
CMS is proposing to drop a $37 Medicare payment to hospitals for "preadministration" services related to intravenous immune globulin therapies in 2009, a move that will "further disrupt" care for those in need of IVIG, according to an industry group