2006 proposed fee schedule - American Society of Clinical Oncology

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overpaying for the costs associated with our lack of online
claims adjudication. We believe that there are likely to be
substantial economies of scale and that the burden
associated with our lack of online claims adjudication would
be relatively similar whether one prescription or multiple
prescriptions were supplied during the same month.
Consequently, in §414.1001 (Basis of payment), we are
proposing changes to the supplying fee for multiple
prescriptions supplied during the same month. We would
continue paying $24 for the first prescription supplied
during a month (or $50 for the first oral immunosuppressive
prescription supplied in the first month after a
transplant). We believe that this $24 supplying fee for the
first prescription would adequately compensate a supplier
for the billing costs associated with the lack of on-line
claims adjudication, and that the cost of supplying
additional prescriptions in the same month should be
comparable to that of other payers. Therefore, in that same
section, we are proposing to pay a supplier an $8 supplying
fee per prescription for any prescription, after the first
one, that that supplier provided to a beneficiary during a
month. If a beneficiary obtained prescriptions at two
separate pharmacies during a one-month period, each pharmacy
would be paid a $24 fee for the first drug it supplied and