Are Part B Rx drug rates higher than other gov’t programs?
By - Medicare Part B lost millions of dollars in 2011 because certain fees were not aligned with the rates that Part D and state Medicaid programs paid, according to a recent Office of Inspector General (OIG) report. Specifically, if Part B rates had been the same as the average Part D rates, Part B would have paid dispensing and supplying fees of $22 million — $110.9 million in savings.
Moreover, OIG estimated that if Part B rates had been the same as the average state Medicaid program rates, Part B would have paid dispensing and supplying fees of $26.6 million, which would have been $106.3 million in savings.
According to OIG, Part B paid nearly $133 million for dispensing and supplying fees for inhalation drugs, immunosuppressive drugs, anticancer drugs, and antimetic drugs in 2011. Previously, the organization noticed a large disparity between the supplying fee amount that Part B paid for immunosuppressive drugs and the amounts Part D sponsors and state Medicaid programs paid.
For this audit, OIG looked at $106,486,093 in Part B dispensing fee payments for 3,740,544 paid claims, as well as $26,410,050 in Part B supplying fee payments for 1,659,643 paid claims in 2011. Quarterly average dispensing fee payment amounts for Part D and State Medicaid programs were calculated and then compared with Part B dispensing and supplying fees.
OIG recommended in its audit that the Center for Medicare & Medicaid Services (CMS) amend current regulations to decrease the Part B payment rates for dispensing and supplying fees to rates similar to those of other payers.
However, CMS did not agree with this recommendation and said that pharmacies that dispense and supply significant amounts of the analyzed drugs state that the higher fees are necessary to support activities associated with dispensing the drugs to Medicare patients. This would include Part B claim submissions or the deliveries of inhalation drugs.
“Our review shows that pharmacies are reimbursed significantly more money for dispensing drugs under Part B when compared with what they are paid for dispensing the same drugs under Part D and Medicaid,” OIG said in its report. “Pharmacists did not identify any additional clinical services or additional handling and storage requirements necessary to provide these drugs to Part B beneficiaries that would justify the substantially higher payment.”
CMS suggested that the OIG undertake a study to identify potential cost differences in dispensing drugs to beneficiaries of Part B versus beneficiaries of Part D or Medicaid. However, the OIG explained that approach would be a useful deployment of its resources and does not plan to currently conduct such a study.
“Should any such differences exist, the notice-and-comment rulemaking process in which CMS would engage to propose lowered Part B dispensing and supplying fees would offer the pharmacy community adequate opportunity to identify differences and help CMS determine the appropriate fees,” OIG said.
