2006 proposed fee schedule - American Society of Clinical Oncology
2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology
124 [If you choose to comment on issues in this section, please include the caption “ESRD-Pricing Methodology” at the beginning of your comments.] In the Revisions to Payment Policies under the Physician Fee Schedule for Calendar Year 2005 final rule, published on November 15, 2004, we determined that for CY 2005, payment for the top 10 separately billable ESRD drugs billed by freestanding facilities would be based on the acquisition cost of the drug, as determined by the OIG, updated by the Producer Price Index (PPI). The remaining separately billable ESRD drugs would be paid at the ASP +6 percent for freestanding facilities. We also determined that hospital-based facilities would continue cost reimbursement for all drugs with the exception of erythopoeitin (EPO) which would be paid the acquisition cost, as determined by the OIG, updated by the PPI. As discussed in section II.H. of this proposed rule, for CY 2006, we are proposing that payment for a drug furnished in connection with renal dialysis services and separately billed by freestanding renal dialysis facilities will be based on section 1874A of the Act. We are also proposing to update the payment allowances quarterly based on the ASP reported to us by drug manufacturers. For CY 2006, we are proposing to continue cost reimbursement for
125 hospital-based facilities; while, proposing to pay for EPO in hospital-based facilities at the ASP +6 percent. 2. Adjustment to Account for Changes in the Pricing of Separately Billable Drugs and Biologicals, and the Estimated Increase in Expenditures for Drugs and Biologicals. [If you choose to comment on issues in this section, please include the caption “ESRD—Drugs and Biologicals” at the beginning of your comments.] Section 623(d) of the MMA, added section 1881(b)(12) of the Act which contains two provisions that describe how the drug add-on adjustment will be implemented in the ESRD payment system. First, that the add-on adjustment reflects the difference between payment methodology for separately billed drugs under the drug price in effect in CY 2004 and current drug pricing and, second, the aggregate payments for CY 2005 must equal aggregate payments absent this MMA provision. In the November 15, 2004 final rule (69 FR 66322), we described in detail the methodology that we used for developing the drug add-on adjustment to the composite rate to account for the difference between estimated drug payments under the average wholesale price (AWP) payment system and the acquisition costs as determined by the OIG. This adjustment was developed so that aggregate spending for
- Page 73 and 74: the ACR. We have accepted the follo
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125<br />
hospital-based facilities; while, proposing to pay for EPO<br />
in hospital-based facilities at the ASP +6 percent.<br />
2. Adjustment to Account for Changes in the Pricing <strong>of</strong><br />
Separately Billable Drugs and Biologicals, and the Estimated<br />
Increase in Expenditures for Drugs and Biologicals.<br />
[If you choose to comment on issues in this section, please<br />
include the caption “ESRD—Drugs and Biologicals” at the<br />
beginning <strong>of</strong> your comments.]<br />
Section 623(d) <strong>of</strong> the MMA, added section 1881(b)(12) <strong>of</strong><br />
the Act which contains two provisions that describe how the<br />
drug add-on adjustment will be implemented in the ESRD<br />
payment system. First, that the add-on adjustment reflects<br />
the difference between payment methodology for separately<br />
billed drugs under the drug price in effect in CY 2004 and<br />
current drug pricing and, second, the aggregate payments for<br />
CY 2005 must equal aggregate payments absent this MMA<br />
provision.<br />
In the November 15, 2004 final rule (69 FR 66322), we<br />
described in detail the methodology that we used for<br />
developing the drug add-on adjustment to the composite rate<br />
to account for the difference between estimated drug<br />
payments under the average wholesale price (AWP) payment<br />
system and the acquisition costs as determined by the OIG.<br />
This adjustment was developed so that aggregate spending for
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