The Centers for Medicare & Medicaid Services (CMS) has posted a file on its Website that contains the payment amounts that will be used to pay for Part B covered drugs for the fourth quarter of 2006. Comparing the fourth quarter 2006 payment amounts with the previous quarter reveals that for the most part average drug prices in the market remain stable. Payment amounts across all drugs and across the top physician administered drugs decreased on average (weighted by Medicare expenditures) by less than one percent. Preliminary 2006 data for the top physician administered drugs suggests that overall utilization of these drugs appears to have increased compared with 2005 levels. For most of the higher volume drugs (42 out of the top 50), the payment amounts changed 2 percent or less, and for 34 of these drugs the change is about 1 percent. Overall, the payment amounts for 26 of the top 50 drugs increased, while 3 remained the same. Among the top drugs with a decrease, in general, there are a number of competitive market factors at work -- multiple manufacturers, alternative therapies, new products, recent generic entrants, or market shifts to lower priced products. Recent studies of Medicare payment rates for oncology drugs by the Department of Health and Human Services Office of Inspector General and the Medicare Payment Advisory Commission have found that physicians are generally able to acquire these drugs at prices below the Medicare reimbursement rate. CMS will continue to support groups representing Medicare Part B drug purchasers, especially small and rural purchasers, to help them identify the most favorable drug prices possible. We continue to monitor IVIG marketplace developments and patients' access to intravenous immune globulin services (IVIG, HCPCS codes J1566 and J1567). CMS and other agencies within the Department of Health and Human Services are continuing to work with manufacturers, providers, patient groups, and stakeholders to better understand the present situation and to assess potential actions that will help to ensure an adequate supply of IVIG and patients receiving appropriate and high quality care. For the third quarter of 2006, the Medicare payment amount increased about 11.9 percent for lyophilized IVIG (powdered form) and 3.5 percent for liquid IVIG. For the fourth quarter of 2006, the Medicare payment amount is increasing an additional 1.5 percent for lyophilized IVIG and 0.7 percent for liquid IVIG. Where applicable, the payment amounts are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. The quarter to quarter price changes are the result of updated data from the manufacturers of these drugs. The ASP payment amounts are available on the CMS websit through the link below. Once you have clicked on the link, scroll down to the Downloads section for October 2006. | | | Downloads |
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