Medicare Compliance & Reimbursement

Drugs may be available through vendors by July 2006.

The Centers for Medicare and Medicaid Services has delayed the Competitive Acquisition Program for Part B drugs after a flurry of criticisms from both physicians and potential vendors.

CMS said it was suspending the bidding process just two days before the final deadline for bids, and would return any bids it had already received. CMS said it would issue a new final rule on the CAP program by the end of the year, and would continue to accept comments until Sept. 6. Vendors will be delivering drugs by July 2006, CMS hopes.

"You can invite people to come to a party but if nobody comes, there's no party," says Judy Stone with Carolina Hematology/Oncology in Charlotte, NC. She says the CAP program, as proposed by CMS, would have been an administrative nightmare in which practices would have to work with vendors who were ill equipped to bill Medicare. Rule Not Practical For Practices The proposal also demonstrated a limited understanding of how community oncology practices work, Stone adds. Some physicians think the CAP sounds like a good idea because they wouldn't have to buy and stock drugs, but they lose interest when they realize how complex the program actually would be, Stone notes.

The CAP, in its current form, wouldn't improve patient care, contends Steve Coplon, grassroots outreach coordinator with the Community Oncology Alliance. Instead, it would make it more complicated to take care of patients, says Coplon, who's also CEO of the West Clinic in Memphis, TN. The current system isn't broken, except for the steep cuts lawmakers imposed on Part B drugs - and the CAP won't fix that problem, Coplon insists. Providers, Vendors Both Faced Challenges Providers balked at the inconvenience of ordering drugs within a narrow window and billing within 14 days after providing the drug or risking audits, says Roberta Buell, vice president of provider services and reimbursement with P4 in Sausalito, CA. Because the CAP didn't include some oncology drugs, providers would still have had to maintain a separate inventory and billing system for non-CAP drugs, and then a third system for non-Medicare drugs.

Providers also worried that vendors would sell data about their practices and their drug-ordering patterns to insurance companies and other third parties, Buell notes. She's seen estimates that only 7 to 8 percent of oncologists would enroll in the CAP.