PPAC Members Scrutinize Part B Drug Proposal
WASHINGTON Members of a Medicare physician advisory group have reservations about the Centers for Medicare and Medicaid Services' proposed new program for paying for physician-administered outpatient drugs under Medicare Part B.
Medicare currently pays physicians the average sales price (ASP) of the druga number that is supposed to represent the total paid for the drug by all buyers divided by the number of units soldplus an additional 6%. But under the proposed rule, beginning next year physicians would have a choice: they could either stick with the current system or obtain the drugs directly from a vendor that will be selected by Medicare via a competitive bidding process.
The system would require that physicians choose one system or the other for all the drugs commonly furnished to their specialty, according to Don Thompson, director of outpatient services at CMS's Center for Medicare Management.
But Ronald Castellanos, M.D., a Cape Coral, Fla., urologist and chairman of the Practicing Physicians Advisory Council, said at a council meeting that an all-or-nothing system wouldn't work very well in his practice. "There are certain drugs that I use that I can't buy for ASP plus 6%."
Mr. Thompson said that while Dr. Castellanos couldn't pick and choose what system he would use for which drug, he could try to influence which urology drugs will be included in the program. "The categories could be structured differently; your comment [on the proposed rule] could be, 'I think the category should include these drugs and not these other drugs,'" Mr. Thompson said at the meeting.
Dr. Castellanos proposed that the council, which advises Medicare on matters of interest to physicians, urge CMS to revise the rule to allow physicians to pick and choose which system they would use "on a drug-by-drug basis." That recommendation passed easily.
Dr. Castellanos wondered whether the drug vendors who are going to contract with Medicare would be required to provide drugs for beneficiaries who couldn't afford the copays.
"The contractor would be required to supply that drug to you," Mr. Thompson replied. "If you're asking if a contractor would waive coinsurance for that particular beneficiary, there's no separate requirement for vendors that would be any different from physicians," who can waive the copay on a case-by-case basis, he said.
Dr. Castellanos pressed further. "These patients have ongoing treatments that can last for years. You're telling me that even though a patient is unable to pay coinsurance, that the contractor will bill the patient, but still has to supply the drug?" he asked.
Mr. Thompson seemed to answer in the affirmative. "We did not propose any mechanism for a contractor to deny supplying drugs to a beneficiary," he said.
