CMS authorizes pass-through payments

Under the Outpatient Prospective Payment System (OPPS), the Centers for Medicare & Medicaid Services (CMS) authorized pass-through payments for Cubicin daptomycin from Cubist (CBST) to treat skin and soft tissue infection (SSTI) caused by Gram-positive bacteria; Risperdal Consta long-acting risperidone from Alkermes (ALKS) and Johnson & Johnson (JNJ) to treat schizophrenia; and Elitek rasburicase from Sanofi- Synthelabo (Euronext:SAN; SNY) to treat and prevent hyperuricemia in cancer patients. Hospitals will receive $0.31 per 1 mg of Cubicin; $131.86 per 12.5 mg of Risperdal; and $105.54 per 0.5 mg of Elitek.

Pass-through payments are made in addition to OPPS base payments for new drugs and devices, whose costs have not been captured in calculating OPPS rates. Pass-through payments are temporary until there is enough cost data to set a price within the OPPS. ...