CMS Releases Q-4 2008 Drug Payment Limits under ASP+6%

The following information is provided by OTN/Onmark, McKesson Specialty Companies, and ANCO Corporate Member.

CMS Releases Q-4 2008 Drug Payment Limits under ASP+6%

On September 16, 2008 CMS posted the Q-4 2008 ASP+6% Drug Payment Limit Files on the drug pages of the CMS Web site, Medicare Part B Drugs Average Sales Price (ASP) Information Resource. As you will see below, there are a number of significant changes to drugs widely administered in oncology offices and HOPD's:

Drug J-Code Q-3 '07 ASP+6% Q-4 '08 ASP+6% % Change
Carboplatin per 50mg J9045 $ 5.23 $ 9.61 + 83.7%
Bleomycin per 15iu J9040 $ 31.52 $ 34.83 + 10.5%
Etoposide per 100mg J9182 $ 4.43 $ 4.84 + 9.3%
Goserelin Acetate Impl. per 3.6mg J9202 $ 177.16 $ 189.45 + 6.9%
Vincristine Sulfate per 1mg J9370 $ 6.47 $ 6.80 + 5.1%
Irinotecan per 20mg J9206 $ 74.75 $ 37.00 - 50.5%
Pamidronate disodium per 30mg J2430 $ 38.21 $ 29.24 - 23.5%
Paclitaxel per 30mg J9265 $ 14.41 $ 11.04 - 23.4%
Granesitron HCL per 100mcg J1626 $ 5.35 $ 4.33 - 19.1%
Amifostine (Ethyol) per 500mg J0207 $ 511.32 $ 424.03 - 17.1%
For the third quarter now the rates reflected in the drug reimbursement files take into account the calculation methodology change mandated MMSEA-2007 for drugs within the multisource/generic category. The data used for the Q-4 2008 ASP+6% reimbursement files is based on the Q-2 2008 sales data submitted to CMS by drug manufacturers on July 31. Reimbursement allowables on NOC drugs were also updated.

The changes are effective October 1 and will remain in effect until either a correction or the next scheduled update by CMS. The next scheduled update will be in December and effective January 1, 2009.

We strongly encourage you to review the entire ASP+6% Drug Payment Limit file which will be available on the OTN Website.