http://www.hallrender.com/health_care_law/library/articles/1276/100512HLN.html
Potential Prescription Drug Audit Areas Highlighted in the OIG’s Fiscal Year 2013 Work Plan
Payments for Drugs Infused Through Medical Equipment Compared to Provider Acquisition Costs. The OIG plans to review provider acquisition costs for Part B covered drugs infused through medical equipment and determine the potential savings if these payments were on the drug’s Average Sales Price (“ASP”). Currently, Part B drugs infused through medical equipment are paid based on average wholesale prices (“AWPs”). The OIG states that AWPs for Part B covered drugs often greatly exceed the actual cost of the drugs.
This appears to be directed at drugs that NECC and others have been producing.. at a lower cost than commercially available products and pain clinics are billing using HCPCS which is basically generic description of drugs with reimbursement allowables tilted toward the cost of the brand name drugs..
We all know that bureaucrats do things looking in the rear view mirror… one can only imagine that these audits look at invoices for all these compounded injectables and reestablish reimbursement allowables based on the costs from those invoices.
It is not too hard of a push to see more – much needed – regulations and oversight of these compounding pharmacies… which will increase their cost/overhead. If these allowables are reduced … will these same compounding pharmacies still have a financially viable business plan?
Will pain clinics just “disappear” from the face of America’s heatlhcare system because they will not long be able to afford the medications that they rely on for their basic treatment?
Filed under: General Problems
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