Part B Insider (Multispecialty) Coding Alert

Published on Thu Apr 27, 2006 PDF

This CAP only has one feather

The Competitive Acquisition Program (CAP) for Part B drugs looks less and less attractive all  the time.

CAP was supposed to solve all of your drug-stocking woes by enlisting the aid of private pharmacy companies. Then the Centers for Medicare & Medicaid Services came up with an overcomplicated program that required you to plan your chemotherapy and other drug administration in advance with no flexibility. And now the CAP has undergone a couple more setbacks.

The program missed a deadline to issue enrollment instructions to physicians. (CMS says the enrollment information is coming shortly.) And instead of multiple pharmacy-benefit companies to choose among, the program will only offer you one vendor: Elmsford, NY-based BioScrip.

CMS insists BioScrip had to go through a rigorous bidding process and prove its ability to service physicians across the country. But since BioScrip is the only company CMS is offering, it seems more likely that it was the only serious contender, say experts.

"This is a very important step in enabling physicians to focus on caring for patients rather than on paperwork and payments for the drugs they administer in their offices," CMS Administrator Mark McClellan said in a release.

Snag: The law requires CMS to offer physicians a choice of at least two vendors, notes Ted Okon, executive director of the Community Oncology Alliance. Congress added that provision so that physicians wouldn't feel trapped with a single vendor, and so there would be a backup if one of the vendors had a catastrophic problem.

The CAP program's launch was delayed from January to July because of problems recruiting vendors, notes Okon. "They're trying to put together a program nationally that nobody has ever done before, even on a test basis."

Although BioScrip is a good company, it would be better to know that there was a second national vendor available if BioScrip has problems, says Okon. BioScrip may also be "a little shocked" to realize that it's carrying the entire program single-handedly, he adds.