2006 proposed fee schedule - American Society of Clinical Oncology

H. Payment for Covered Outpatient Drugs and Biologicals
233
[If you choose to comment on issues in this section, please
include the caption “Payment for Covered Outpatient Drugs
and Biologicals” at the beginning of your comments.]
Medicare Part B covers a limited number of prescription
drugs and biologicals. For the purposes of this proposed
rule, the term “drugs” will hereafter refer to both drugs
and biologicals. Medicare Part B covered drugs not paid on
a cost or prospective payment basis generally fall into
three categories:
● Drugs furnished incident to a physician’s service.
● DME drugs.
● Drugs specifically covered by statute
(immunosuppressive drugs, for example).
Beginning in CY 2005, the vast majority of Medicare
Part B drugs not paid on a cost or prospective payment basis
are paid under the ASP methodology. The ASP methodology is
based on data submitted to us quarterly by manufacturers.
In addition to the payment for the drug, Medicare currently
pays a dispensing fee for inhalation drugs, a furnishing fee
for blood clotting factors, and a supplying fee for certain
Part B drugs.
This section of the preamble discusses proposed changes
and issues related to the determination of the payment
amounts for covered Part B drugs and the separate payments