2006 proposed fee schedule - American Society of Clinical Oncology

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pays for DME and associated supplies, including inhalations
drugs that are necessary for the operation of the nebulizer.
Metered-dose inhalers (MDIs) are another mode of delivery
for inhalation drugs. MDIs are considered disposable
medical equipment (for which there is no current Medicare
Part B benefit category), and consequently are not currently
covered under Part B. Beginning in CY 2006, coverage for
MDIs will generally be available through the Medicare Part D
benefit. This represents an important expansion in the
options available to beneficiaries for inhalation drug
coverage under Medicare. With Medicare coverage of both
delivery methods available, we anticipate that physicians
will choose the option that best suits a patient’s
particular needs consistent with the applicable standards of
medical practice. We expect that both modes of inhalation
drug delivery will play an important role in the Medicare
program in the years to come.
Prior to CY 2004, most Medicare Part B covered drugs,
including inhalation drugs, were paid at 95 percent of the
AWP. Numerous studies by the OIG and General Accounting
Office (GAO) indicated that 95 percent of AWP substantially
exceeded suppliers’ acquisition costs for Medicare Part B
drugs, particularly for the high volume nebulizer drugs,