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Plasma Protein Therapeutics Association Urges CMS For Appropriate Hospital Outpatient Drug Reimbursement
Date:8/11/2009

ANNAPOLIS, Md., Aug. 11 /PRNewswire/ -- The Plasma Protein Therapeutics Association (PPTA) supports the favorable recommendation of average sales price (ASP) + 6 percent for reimbursement of separately paid drugs and biologics in the hospital outpatient setting made by the Centers for Medicare and Medicaid Services' (CMS) Advisory Panel on Ambulatory Payment Classification (APC) at its August 5-7 meeting, although third party data maintains that ASP +12 percent is the appropriate reimbursement level.

PPTA presented the APC Panel with compelling evidence demonstrating that setting the current ASP + 4 percent payment rate was based to some extent on flawed hospital claims data and is insufficient to assure patient access to lifesaving plasma protein therapies.

PPTA's comments as part of the stakeholder panel focused largely on evidence that sales into the 340B Drug Discount Pricing Program are skewing CMS's rate setting calculation in the Outpatient Prospective Payment System (OPPS). Further, health care reform legislation if enacted will exacerbate the disparity, given that proposals to expand 340B and to increase the Medicaid outpatient drug rebate percentage will result in a larger volume of products being sold at significantly deeper discounts to 340B hospitals.

In its testimony, PPTA referenced data compiled by The Moran Company, a Washington, D.C.-based health care research and consulting firm, which revealed that removing 340B sales from the rate setting and reallocating the $150 million CMS has proposed to move from packaged drugs to separately payable drugs to cover pharmacy overhead costs results in the more appropriate ASP +12 percent reimbursement level.

The 340B program limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health centers, qualified disproportionate share hospitals and hemophilia treatment centers. The progr
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SOURCE Plasma Protein Therapeutics Association
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