Medicare To Reimburse Hospitals for tPA Administered to Stroke Patients
Medicare for the first time will soon begin reimbursing hospitals specifically for the administration of tissue plasminogen activator in ischemic stroke patients, marking "what promises to create a major change in the treatment of acute stroke patients in the U.S.," the Wall Street Journal reports.
The drug, known as tPA, is administered intravenously in the first three hours following a stroke caused by a blood clot in an artery. The drug dissolves clots and improves blood flow.
Made by California-based Genentech, tPA is the only clot-dissolving agent with FDA approval to treat ischemic stroke. Up to 80% of 700,000 stroke patients in the U.S. annually could benefit from tPA, which costs $2,000 or more per dose, according to the Journal.
Medicare currently reimburses hospitals a flat rate of about $5,700 per case of stroke, regardless of whether the drug is administered. As a result, "cost has caused hospitals to shy away from using the medicine," the Journal reports.
Under a change to be published next week in the Federal Register, Medicare will begin paying hospitals a base rate that is about $6,000 more per stroke case if tPA is administered. Actual reimbursements will vary by region and hospital. Medicare officials said the $6,000 in additional funding for administration of tPA is intended to cover the cost of the drug and the additional diagnostic tests and other therapy generally ordered when tPA is used.
Genentech said the reimbursement change acknowledges the importance of treating stroke patients with clot-dissolving drugs but predicted that the impact will be "minimal."
Joseph Broderick, chief of neurology at the University of Cincinnati, said the decision was "as important as any development since tPA was demonstrated as the first effective treatment for ischemic stroke in 1995."
The change, along with several others to be detailed in the Federal Register, will go into effect on Oct. 1 (Burton, Wall Street Journal, 8/4).