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PPTA Urges CMS for Appropriate Hospital Outpatient Reimbursement for Plasma Protein Therapies
Date:8/18/2011

ANNAPOLIS, Md., Aug. 18, 2011 /PRNewswire/ -- The Plasma Protein Therapeutics Association (PPTA) recommends that the Centers for Medicare and Medicaid Services (CMS) take necessary steps to improve drug reimbursement under the Hospital Outpatient Perspective Payment System (OPPS).

At last week's Advisory Panel on Ambulatory Payment Classification (APC) Groups meeting, PPTA testified that the continued failure by CMS to remove hospitals that purchase drugs under the 340B program from its OPPS reimbursement rate-setting calculation may create difficulties for patients in their attempt to access some drugs and biologicals because including 340B sales in the calculation artificially lowers the payment level.

The agency sets the payment level for separately payable drugs and biologicals with non-pass-through status based on their ratio of cost to average sales price (ASP).  The cost totals are based on claims data from all hospitals, including 340B hospitals, but the ASP data excludes 340B sales. Setting the rate in this manner does not reflect the actual cost of acquiring and preparing drugs and biologicals for any hospitals, because 340B sales prices are well below ASP.  For those hospitals not receiving the 340B discount on drug purchases, their reimbursement level may become too low to be able to continue offering certain drugs and biologicals to their patients for administration.

Based on this calculation, CMS has proposed for calendar year 2012 to set the payment level of separately payable non-pass-through drugs and biologicals, which include most plasma protein therapies, at ASP plus 4 percent. The current payment level is ASP plus 5 percent.  PPTA believes, however, that this payment rate should be no less than ASP plus 6 percent to help ensure that hospital outpatient departments remain a viable option for beneficiaries to receive therapies such as alpha-1 proteinase inhibitor, blood clotting factors and intravenous immune
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SOURCE Plasma Protein Therapeutics Association (PPTA)
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