Home Health & Hospice Week

Albuterol is up but ipratropium bromide is down, latest fee schedule indicates.

The Centers for Medicare & Medicaid Services released its second-quarter Part B drug fees to ambivalent reviews from respiratory drug suppliers. While the fees for some staple drugs will rise, others will actually decline.

The good news: Fees for albuterol (HCPCS code J7613) will climb from 6.5 cents to 9 cents per milligram.

The not-so-good news: Fees for ipratropium bromide (J7644) will fall from 29 cents to 20.2 cents per milligram.

"I expected to see some changes upward, but I didn't expect to see any changes downward," Wayne Stanfield, executive director of the Home Care Alliance of Virginia, tells Eli.

The downward adjustment in the ipratropium bromide fee especially concerns Stanfield. It might lead some suppliers to stop offering the drug altogether, he warns.

Under the Medicare Modernization Act, Part B drugs fees are based on the average sales price plus 6 percent, updated quarterly. The recently released fees will be effective from April 1 through June 30, and are based on ASPs for the drugs during the fourth quarter of 2004.

Price hikes are also in store this quarter for concentrated levalbuterol (J7612), which is up by 2 cents to 89.1 cents per half-milligram; for levalbuterol unit dose (J7614), up 13.9 cents to $1.417 per half-milligram; and for albuterol compound solution, up 1.8 cents to $2.623 per unit.

But the price for the concentrated form of albuterol (J7611) will actually decrease slightly, from 7.1 cents to 6.9 cents per milligram.

The volatility in the drug fees after just one quarter of the new pricing system raises red flags for Stanfield.

"I was surprised to see as much change as there was," he says. "Perhaps manufacturers are not dealing with the new system very well."

Editor's note: The new drug fee schedule is at www.cms.hhs.gov/providers/drugs/asp.asp.