Home Health & Hospice Week

More data needed to determine appropriate device, experts say.

Companies that supply nebulizers to Medicare patients should brace for possible changes in their business when the program's prescription drug benefit takes effect next year.

With the implementation of the Part D benefit in January 2006, Medicare will begin paying for inhalation drugs delivered by metered dose inhalers - disposable devices that the Centers for Medicare & Medicaid Services says are less expensive and easier to use than nebulizers.

The change could impact nebulizer utilization, industry experts warn. Whether it does depends on how honest physicians have been in attesting that MDIs are ineffective for their nebulizer patients.

"In order for me to supply aerosol unit dose drugs, physicians have to say that they have tried the metered dose inhalers and ruled them out," Home Care Alliance of Virginia Executive Director Wayne Stanfield tells Eli. "The unknown is, how many times are they not truthful because they know Medicare doesn't pay for the metered dose inhalers?"

While the MDI is the preferred method for delivering bronchodilators and steroids, nebulizers can convert liquids into aerosols, and some inhalation drugs are available only in solution form.

In addition, some older people can't tolerate MDIs, observes Jacki McClure, a respiratory therapist who directs the Lubbock, TX-based MED Group's respiratory network.

"We need more clinical data to show that with a certain population it would be better to use the nebulizer," McClure says. "There also needs to be more data to show when nebulization of the inhaled medication is the preferred route."

CMS is seeking comments about the impact of coverage for MDI inhalation drugs as part of its proposed 2006 physician fee schedule rule.