2006 proposed fee schedule - American Society of Clinical Oncology

composite rate plus separately billed drugs would remain
budget neutral for CY 2005.
Section 1881(b)(12) of the Act also contains two
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provisions related to adjustments to payments for drugs and
biologicals for CY 2006. First, section 1881(b)(12)(C)(ii)
of the Act provides that we recalculate the add-on
adjustment to reflect the drug pricing methodology applied
by the Secretary under section 1881(b)(13)(A)(iii) of the
Act. That is, we must compute the drug add-on adjustment
based on the difference between estimated payments using the
AWP payment methodology and the proposed new payment
methodology using ASP +6 percent.
In addition, section 1881(b)(12)(F) of the Act requires
that, beginning in 2006, we establish an annual update
adjustment to reflect estimated growth in expenditures for
separately billable drugs and biologicals furnished by ESRD
facilities. This update would be applied only to the drug
add-on portion of the composite rate. In order to meet both
requirements, we are proposing to develop the CY 2006 drug
add-on adjustment in two steps.
First, we would recalculate the CY 2005 add-on
adjustment to reflect the difference in drug payments using
95 percent AWP pricing and payments using ASP +6 pricing.
This calculation would replace the current 8.7 percent
adjustment and would be budget neutral to CY 2005 payments.