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
(1) Historical Drug Expenditure Data To develop the drug add-on adjustment we used historical total aggregate payments for separately billed 128 ESRD drugs for half of CY 2000 and all of CY 2001, CY 2002 and CY 2003. For EPO, these payments were broken down according to type of ESRD facility (hospital-based versus independent). We also used the number of dialysis treatments performed by these two types of facilities over the same period. (2) ASP +6 Percent Prices We obtained the ASP +6 percent prices, for the second quarter of CY 2005, as shown in the following table. For purposes of this proposed rule, we have used the latest ASP pricing available, which are second quarter prices. For the final rule, we will have prices for all 4 quarters of CY 2005 and plan to develop prices representing the average CY 2005 ASP payments for the drugs listed in Table 20 below. TABLE 20 Drugs Second Quarter ASP +6 Percent Epogen $9.25 Calcitriol $0.86 Doxercalciferol $2.78 Iron_dextran $11.22 Iron_sucrose $0.37 Levocarnitine $11.12 Paricalcitol $3.97 Sodium_ferric_glut $4.73 Alteplase, Recombinant $30.09
Drugs Second Quarter ASP +6 Percent Vancomycin $3.19 (3) Estimated Medicare Payments using 95 Percent of AWP In order to estimate AWP payments we used the first quarter 2005 AWP prices and updated them to the second 129 quarter by applying, for drugs other than EPO, an estimated AWP quarterly growth of approximately 0.74 percent (annual growth factor of 3 percent). This growth factor is based on historical trends of AWP pricing (for all drugs) for the year 1997-2003. We did not increase the payment rate for Epogen since payment was maintained at $10.00 per thousand units prior to MMA. (See Table 21.) TABLE 21 Drugs AWP Rates for the Second Quarter of 2005 Epogen $10.00* Calcitriol $1.40 Doxercalciferol $3.11 Iron_dextran $18.04 Iron_sucrose $0.66 Levocarnitine $36.75 Paricalcitol $5.37 Sodium_ferric_glut $8.23 Alteplase, Recombinant $38.82 Vancomycin $5.55 *Statutory rate. (4) Dialysis Treatments We updated the number of dialysis treatments by the actuarial projected growth in the number of ESRD beneficiaries. Since Medicare covers a maximum of three treatments per week, utilization growth is limited, and,
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(1) Historical Drug Expenditure Data<br />
To develop the drug add-on adjustment we used<br />
historical total aggregate payments for separately billed<br />
128<br />
ESRD drugs for half <strong>of</strong> CY 2000 and all <strong>of</strong> CY 2001, CY 2002<br />
and CY 2003. For EPO, these payments were broken down<br />
according to type <strong>of</strong> ESRD facility (hospital-based versus<br />
independent). We also used the number <strong>of</strong> dialysis<br />
treatments performed by these two types <strong>of</strong> facilities over<br />
the same period.<br />
(2) ASP +6 Percent Prices<br />
We obtained the ASP +6 percent prices, for the second<br />
quarter <strong>of</strong> CY 2005, as shown in the following table. For<br />
purposes <strong>of</strong> this <strong>proposed</strong> rule, we have used the latest ASP<br />
pricing available, which are second quarter prices. For the<br />
final rule, we will have prices for all 4 quarters <strong>of</strong><br />
CY 2005 and plan to develop prices representing the average<br />
CY 2005 ASP payments for the drugs listed in Table 20 below.<br />
TABLE 20<br />
Drugs<br />
Second Quarter<br />
ASP +6<br />
Percent<br />
Epogen $9.25<br />
Calcitriol $0.86<br />
Doxercalciferol $2.78<br />
Iron_dextran $11.22<br />
Iron_sucrose $0.37<br />
Levocarnitine $11.12<br />
Paricalcitol $3.97<br />
Sodium_ferric_glut $4.73<br />
Alteplase, Recombinant $30.09
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