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Medicare Compliance & Reimbursement

PHARMACEUTICALS:

Providers Frustrated By CMS CAP Get Relief

Published on Fri Jun 24, 2005

Now, doctors get a weeklong window to provide drugs.

While it is far from a complete cave-in on its part, the Centers for Medicare and Medicaid Services bowed to a couple providers' concerns about the Competitive Acquisition Program for Part B drugs.

For one thing, CMS issued an interim final rule instead of a plain final rule. That means providers have another two months to comment on the rule, which came out in the July 6 Federal Register.

Also, the new rule states that physicians can name a seven-day period during which they plan to administer drugs. Allowing physicians to specify a seven-day window for providing a drug instead of pinpointing the date on which they'll administer it is "a little more realistic," but still not very workable, claims Albuquerque, NM oncologist Barbara McAneny, a leading critic of the CAP on the Practicing Physicians Advisory Council.

"What they're asking us to do is to predict when somebody's counts come back up or when the infection will clear up," McAneny says.

The CAP will cover 169 drugs that CMS believes are most commonly administered incident to physicians services. Physicians who sign up for the CAP will obtain these drugs directly from a vendor, which will bill Medicare for the drug. The 169 drugs don't include vaccines, such as tetanus and diphtheria, which physicians administer in emergency situations. They also don't include contrast agents, at least for now.

CMS also won't include leuprolide among the covered drugs, because many carriers apply their own "least costly alternative" policies to this drug. And blood products, including blood-clotting factors and intravenous immune globulin, also won't be part of the CAP.

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