2006 proposed fee schedule - American Society of Clinical Oncology

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separate supplying fee is paid for each prescription, except
when different strengths of the same drug are supplied on a
single day. In the November 15, 2004 final rule, we
indicated that we were establishing a supplying fee that was
higher than that of other payers due to the lack of on-line
claims adjudication for Medicare Part B oral drugs. Other
than the cost of billing Medicare Part B, we indicated that
we did not believe there were any other significant cost
differences between Medicare and other payers that justified
a higher Medicare supplying fee for these drugs. We noted
in last year’s final rule that many other payers with online
adjudication have dispensing fees in the range of $5 to $10
per prescription. We also indicated that we had received
comments that the average cost to a pharmacy to dispense a
non-Medicaid third party or cash prescription for those
drugs ranges anywhere from $7.50 to $8.00.
When multiple drugs are supplied to a beneficiary on
the same day or in the same month, current policy is to pay
a full supplying fee for each additional drug. As mentioned
previously, we established a supplying fee higher than that
of other payers to compensate for the added costs associated
with our lack of online claims adjudication. However, in
situations where multiple drugs are supplied to a
beneficiary during the same month, many of which are likely
to be supplied on the same day, we are concerned that we are