Medicare Compliance & Reimbursement

Oncology drugs overpriced by as much as 185 percent

Five commonly billed oncology drugs are at least 5 percent cheaper than the prices Medicare pays physicians for them, the HHS Office of Inspector General (OIG) claims in a new survey.
 
The OIG claims that carboplatin (J9045) is overpriced by a startling 185.1 percent, dexamethasone sodium phosphate (J1100) is overvalued by 65.2 percent, and dolasetron mesylate (J1260) is 55.6 percent too expensive. The survey found two other drugs, vinorelbine tartrate (J9390) and granisetron HCI (J1626), also had double-digit overpayments.
 
The drugs were overpriced for a number of reasons, including "prompt pay" discounts which reward you for paying the manufacturer immediately for a drug.
 
Cuts could be coming: The law requires the Centers for Medicare & Medicaid Services to slash drug payments if the OIG finds at least a 5-percent overpayment. But CMS once again insisted that the OIG's data did not take into account decreases that happened since last year. The OIG retorted that even with recent cuts, the drugs are still way more than 5 percent overvalued.