2006 proposed fee schedule - American Society of Clinical Oncology

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representing 42 percent of the market, which indicated wide
variation across companies in the patient monthly cost of
dispensing inhalation drugs from a low of $7 to a high of
$204.3 The GAO report indicated that the wide variation in
supplier costs is due, in part, to variation in the services
suppliers offer and that some of the costs incurred by
suppliers may not be necessary to dispense inhalation drugs,
for example, marketing, overnight shipping, and 24-hour
hotlines.
In light of the substantial changes occurring in
inhalation drug reimbursement in 2005, we viewed 2005 as a
transitional year. With the wide variation in the reported
costs and services provided by inhalation drug suppliers
suggested by the comments and the GAO study, we stated in
last year’s final rule that we would establish an interim
dispensing fee for inhalation drugs applicable for CY 2005
and reconsider the issue for CY 2006. The 2005 dispensing
fee for a 30-day supply of inhalation drugs was based on the
industry recommended $68 fee from AAH study, excluding
certain costs that Medicare generally does not reimburse
regardless of the scope of the Medicare benefit (that is,
sales and marketing, bad debt, and an explicit profit
margin). The resulting fee established for a 30-day supply
of inhalation drugs was $57 for CY 2005. This CY 2005 fee
3 GAO, “Appropriate Dispensing Fee Needed for Suppliers of Inhalation Therapy Drugs,” GAO-05-72, October 2004.