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CMS-1403-FC
updated through December 31, 2007 (that is, claims with
dates of service from January 1 through December 31, 2007,
that were received, processed, paid, and passed to the
National Claims History File as of December 31, 2007). For
this final rule with comment period, we are using
additional updated CY 2007 claims with dates of service for
the same time period. This updated CY 2007 data file will
include claims received, processed, paid, and passed to the
National Claims History File as of June 30, 2008.
For the CY 2009 PFS proposed rule, we adjusted the
December 2007 file to reflect our estimate of what total
drug expenditures would be using the final June 30, 2008
bill file for CY 2007. The net adjustment we applied to
the CY 2007 claims data was an increase of 12.6 percent to
the December 2007 claims file. To calculate the proposed
per patient utilization growth, we removed the enrollment
component by using the growth in enrollment data between CY
2006 and CY 2007. This was approximately 3 percent. To
remove the price effect, we calculated the weighted change
between CY 2006 and CY 2007 ASP pricing for the top eleven
ESRD drugs. We weighted the differences using 2007 ESRD
facility drug expenditure data.
This process led to an overall 1.8 percent reduction
in price between CY 2006 and CY 2007.
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