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October 1, 2014
Investigators Recommend Lowering Part B Fees;
CMS Refuses

Washington, D.C.—A new report from the Department of Health & Human Services (HHS) seeks to lower Medicare Part B fees paid to pharmacists for dispensing several types of specialty drugs, but the higher payments were defended by none other than the Centers for Medicare and Medicaid Services (CMS).

The investigation from the HHS Office of Inspector General (OIG) notes that Medicare Part B pays a dispensing fee for inhalation drugs administered through durable medical equipment, as well as a supplying fee for immunosuppressive drugs associated with immunosuppressive organ transplant drugs, oral anticancer chemotherapeutic drugs, and oral antiemetic drugs used as part of an anticancer chemotherapeutic regimen. Part B payments for those dispensing and supplying fees were nearly $133 million in 2011, according to the OIG.

“In previous work, we noticed a large disparity between the supplying fee amount that Part B paid for immunosuppressive drugs and the amounts Medicare Part D sponsors and state Medicaid programs paid,” according to report authors.

Compared to the $132,896,143 in dispensing and supplying fees paid by Part B, “we estimated that if Part B rates had been the same as the average Part D rates, Part B would have paid dispensing and supplying fees of $22,033,834, a savings of $110,862,309. We also estimated that if Part B rates had been the same as the average state Medicaid program rates, Part B would have paid dispensing and supplying fees of $26,608,766, a savings of $106,287,377,” report authors write.

The HHS OIG recommended that CMS amend current regulations to decrease the Part B payment rates for pharmacists who dispense and supply the drugs to fees similar to those of other payers, such as Part D and Medicaid.

CMS refused to concur with that recommendation, however. In written comments, the agency said the report provided useful information about payment differences, but that pharmacies dispensing and supplying significant amounts of those drugs maintain that the higher fees are necessary. The payments are greater, according to CMS, because of increased costs to dispense the drugs to Medicare patients, such as Part B claim submission or the delivery of inhalation drugs.

The issue isn’t settled, however.

Before the OIG recommendations could be considered, CMS said, a study would need to identify the specific activities involved with dispensing inhalation drugs and supplying oral drugs under Part B and collect information about the actual costs that are directly associated with dispensing and supplying the Part B drugs.

OIG refused to do the study, because in the original review, “pharmacists did not identify any additional clinical services or additional handling and storage requirements necessary to provide these drugs to Part B beneficiaries that would justify the substantially higher payment.”

Instead, the report authors argue, “Should any such differences exist, the notice-and-comment rulemaking process in which CMS would engage to propose lowered Part B dispensing and supplying fees would offer the pharmacy community adequate opportunity to identify differences and help CMS determine the appropriate fees.”


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