Part B Insider (Multispecialty) Coding Alert

Published on Thu Nov 03, 2005 PDF

Struggling oncologists could have a little extra help soon. If you've been routinely waiving copayments for poor beneficiaries, then you'll welcome a new idea from the Medicare Payment Advisory Commission.

At its November meeting, MedPAC drafted a recommendation that Congress establish an interim fund to help beneficiaries pay their copayments for Part B drugs, including cancer drugs. The fund would come from voluntary donations from pharmaceutical companies. In the long term, Congress would have to find another solution to the problem of drug copayments.

MedPAC is due to report to Congress in January on whether oncologists are having trouble making ends meet with drug payments based on average sales price plus 6 percent. A recent HHS Office of Inspector General report found that most oncologists could afford to buy drugs at around the ASP+6 amounts. MedPAC drafted a recommendation that would ask the OIG to study prices after the system had been in place for a year.

Another draft recommendation would call on the Centers for Medicare & Medicaid Services to carve out an exception in the Competitive Acquisition Program (CAP) to allow CAP vendors to deliver drugs to a clinic's main location instead of
a rural satellite office. Often, satellite locations don't have the facilities to mix the drugs, but the CAP will require vendors to send the drugs to the locations where they'll be administered.