ARTICLE | Politics & Policy

CMS issues Part B proposal

July 28, 2004 7:00 AM UTC

The Centers for Medicare & Medicaid Services (CMS) issued its proposed rule on a revised 2005 Physician Fee Schedule, or Part B plan, in which the agency provided preliminary reimbursement rates for 32 widely used Part B drugs based on the new "average sales price" methodology. The ASP methodology sets reimbursement for most drugs at 106% of ASP, which is based on drug pricing data submitted to CMS by manufacturers on a quarterly basis. Previously, reimbursement was based on 95% of the average wholesale price (AWP).

Of the 32 covered drugs listed, eight have increased or flat reimbursement rates for 2005. For the remaining drugs, proposed reimbursement rates decreased by 2%-89% compared to 2004 rates. For example, in 2005 CMS proposes to decrease reimbursement by 15% for anemia drug Aranesp darbepoetin alfa from Amgen ([*AMGN*]) to $18.10 from $21.20. Other drugs that would have reduced reimbursement include Aloxi palonosetron from MGI Pharma ([*MOGN*]) and Eligard leuprolide from Atrix ([ATRX*]). Reimbursement for Aloxi to prevent chemotherapy-induced nausea and vomiting would be cut by 34% to $202.51 from $307.80. Reimbursement for the various forms of prostate cancer drug Eligard would be decreased by 53% to $234.28 from $500.58. ...