2006 proposed fee schedule - American Society of Clinical Oncology

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of the increase to the drug add-on and the changes in drug
prices which are explained in section G below.
The fifth column shows the effect of the proposed
changes in drug payments to ESRD providers. Current
payments for drugs represent 2005 Medicare reimbursement
using AAP prices for the top ten drugs (as discussed earlier
in this preamble). Current Medicare spending for the top
ten drugs is estimated using 2005 AAP prices times actual
drug utilization from 2004 claims. (EPO units are estimated
using payments because the units field on bills represents
the number of EPO administrations rather than the number of
EPO units). Spending under the proposed change is 2005
ASP +6 percent for the top ten drugs times actual drug
utilization from 2004 claims. The proposed prices for these
top ten drugs are discussed earlier in this preamble. In
order to simulate what ASP +6 percent pricing will be in
2006 we inflated the 2005 first quarter ASP +6 prices by a
forecast of the PPI for prescription drugs (5.7 percent
annual growth from 2005 to 2006).
Proposed payment for drugs in 2006 also includes the
8.9 percent drug add-on to the composite rate. This amount
is computed by multiplying the wage adjusted composite rate
for each provider times dialysis treatments from 2004
claims. Column 5 is computed by comparing spending under
the proposed payment for drugs (ASP +6 percent inflated to