OIG Report: Medicare Part B Overpaying for Infusion Medications
Medicare Part B is paying 54% to 122% more than the market price for infusion drugs -- medications administered by a needle or catheter -- because the payments are based on wholesale prices rather than average sales prices, according to a new reportÂ by the HHS Office of Inspector General,Â The Hill's "RegWatch" reports.Â
OIG Report Details
Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Medicare reimbursed most drugs based on their average sales prices. However, infusion drugs were excluded from the legislation and sold based on wholesale prices set by drugmakers.Â
The report found that Medicare could spend 44% less on the drugs if it reimbursed providers based on the average sales price, which would have resulted in savings of $334 million between 2005 and 2011.Â
OIG recommended that CMS "seek legislative change" over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to "RegWatch," CMS "partially" has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, "RegWatch," The Hill, 2/20).
Medicare Beneficiaries Prefer Low-Cost Rx Plans, Report Finds
In related news, Medicare beneficiaries "overwhelmingly" favor prescription drug plans with low monthly premiums, according to a reportÂ released Wednesday by Avalere Health,Â The Hill's "Healthwatch" reports.Â
The report found that almost three million beneficiaries have selected lower-cost plans that use preferred pharmacy networks to keep costs down. In addition, low-cost plans have seen an increase in enrollment, such as the AARP Saver Plus plan that already ranks as the ninth-most popular plan despite its recent market entry.Â
Avalere Senior Vice President Bonnie Washington said, "The shift of enrollees to low-cost plans validates that market competition works."
The report also projected Medicare Part D premiums would remain stable, estimating premium increases of just 2% between 2012 and 2013 (Viebeck, "Healthwatch,"Â The Hill, 2/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.