BioScrip, Inc. is the approved CAP vendor for the Competitive Acquisition Program (CAP) for certain Part B drugs and biologicals.

Drugs Supplied Under the CAP

Lists of drugs supplied by the approved CAP vendor for each quarter of the CAP appear in the Downloads section below. The lists include the specific NDCs that the vendor supplies.

Approved CAP Vendors may request the addition of new drugs to their CAP drug lists.  Written requests for changes must be submitted to CMS and the CAP designated carrier.  If CMS determines that the new drug is appropriate for inclusion on the Approved CAP Vendor's drug list, changes will become effective in a subsequent quarter.  Requests for additions to the CAP drug list must be submitted at least 4 months prior to the desired effective date.

Other Vendor Information

BioScrip's Vendor Identification Number (VIN) is Q103.

A link to BioScrip's website which contains contact information for the CAP is in the Related Links Outside CMS section below.

The address that a local carrier or MAC should use for correspondence related to appeals and BR 5207.7.2 is:

    BioScrip, Inc.
    Attention: CAP Department
    2791 Charter Street
    Columbus OH  43228

The CAP NOC drug list identifies drugs which an approved CAP vendor may request to have added to the list of drugs that the vendor supplies under the CAP. Drugs on the CAP NOC drug list are not available through the CAP until requested by an approved CAP vendor, cleared by CMS, and placed on the list of drugs supplied by a CAP vendor. The CAP NOC drug list appears in the Downloads section below.

Billing of CAP Coinsurance to Beneficiaries with no Supplemental Insurance

A Question and Answer (Q&A) document on this subject is posted in the Downloads section below.

For updated information about the physician election period, click on the "Information for Physicians" link on the left margin of the page.

CAP Vendor Qs & As

Qs & As about the post payment review process authorized by the Tax Relief and Health Care Act of 2006 (TRHCA) and the collection of beneficiary cost sharing amounts appear in the Downloads section below.

2008 Medicare Part B Drug CAP Payment Amount Update

The payment amounts for CAP drugs were initially based on bids submitted for each drug by potential vendors during the bidding process. The payment amounts were updated for 2008 based on the change in the reasonable net acquisition cost (RNAC) incurred for acquiring CAP drugs.

• The percent change in RNAC for 2008 was calculated based on vendor-supplied data. This percent change in RNAC was also used as a proxy for the percent change in RNAC for vendors that initially bid but are not in the CAP program.
• The updated payment amounts were calculated based on the average of the bid prices as adjusted by the percent change in RNAC.

The updated CAP payment amount for all weighted drugs in the CAP category is limited by the weighted ASP payment amount across those drugs in the category. Therefore some individual weighted CAP drugs may be paid at amounts greater that ASP+6%, but the overall weighted payment amount is limited at ASP+6%. The CAP payment amount limit for each unweighted drug equals the ASP payment amount.

The 2008 CAP payment amounts are effective from 1/1/2008 until 12/31/2008.        

Downloads
CAP HCPCS codes and Price File effective January 1, 2008 [PDF, 14KB] TRHCA Q&A: Post payment review [PDF, 13KB] TRHCA Q&A: Assurance of CAP Drug Administration and Beneficiary Cost Sharing  [PDF, 15KB] CAP Drug List Updated 4/1/2007 [PDF 106KB] January 2008 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 166KB] January 2007 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 170KB] October 2006 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 166KB] June 2006 List of Drugs Supplied Under the CAP, Corresponding NDCs, and Vendor VIN [PDF, 159KB] May 2006 List of Drugs Supplied Under the CAP, CAP Payment Amounts and Vendor VIN [PDF, 240KB] CAP NOC Updated 1/12007 [PDF 28KB] Q&A on Billing of CAP Coinsurance [PDF, 25KB]
Related Links Inside CMS
Press Release for Announcement of the Approved CAP Vendor
Related Links Outside CMS
Approved CAP Vendor (BioScrip, Inc.)

Page Last Modified: 06/30/2008 10:37:10 AM
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