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

globulin (IVIG). "PPTA has long advocated for parity between the statutory physician office rate of ASP plus 6 and the OPPS rate," said Julie Birkofer, senior vice president, North America, PPTA. "This inequality between sites of service has been problematic in the past for patient access to plasma protein therapies."

PPTA testimony also underscored the staggering growth of 340B hospital sites in recent years.  The number of 340B hospital sites has more than doubled in three years – from 2,213 enrolled in the fourth quarter of 2008 to 4,427 enrolled today.  This growth of the 340B program will exacerbate the flawed nature of the agency's rate setting calculation, according to PPTA.  

Although PPTA advocates for removing 340B sales from the CMS rate setting calculation, it cautioned against establishing two payment rates – one for 340B hospitals and one for non-340B hospitals.  "Reducing Medicare payments to 340B hospitals [through a separate payment rate] for separately paid drugs would undermine the purpose of the 340B program to reach more eligible patients and provide more comprehensive services," said Birkofer.

Maintaining an appropriate reimbursement level is an important step in ensuring access to plasma protein therapies, which are highly complex biologics, for Medicare beneficiaries suffering from rare, chronic and genetic diseases and disorders including primary immunodeficiency diseases, hemophilia and other bleeding disorders and alpha-1 antitrypsin deficiency, a genetic lung disease. Plasma protein therapies refer to plasma-derived and recombinant blood clotting factors, as well as alpha-1 proteinase inhibitor and immune globulins.

PPTA testified as part of a panel of stakeholders advocating to improve drug reimbursement under OPPS and providing input on the 2012 OPPS Proposed Rule. The group comprised representatives from the Association of Community Cancer Center
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SOURCE Plasma Protein Therapeutics Association (PPTA)
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