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OIG Report Suggests Infusion Drugs be a part of Competitive Bidding

In a report from OIG to CMS, it was recommended that infusion drugs reflect provider acquisition costs when it comes to Medicare reimbursements. The idea of including DME infusion drugs in the competitive bidding program:

Therefore, OIG continues to recommend that: CMS take action to ensure that Medicare payment amounts for DME infusion drugs more accurately reflect provider acquisition costs. The agency could choose to seek a legislative change that would require payments for DME infusion drugs to be based on ASPs. We recognize that seeking such a change through the legislative proposal process would not, in itself, change payments unless Congress chooses to enact this change. Another available option would be for CMS to use its existing authority to include DME infusion drugs in the competitive bidding program as soon as possible.

Commentary from Stephanie Hookham – VGM Infusion:

The flaw in cutting reimbursement for Medicare B covered infusion drugs, like Milrinone lactate, under the current AWP reimbursement system is the failure to understand the clinical acuity of the therapy, the expense of the drug preparation facility as well as the depth of clinical professionals involved (pharmacy and nursing) for an off-site patient.

We know first-hand how important these components are when one considers how Medicare missed the mark in providing home infusion drug benefits to Medicare D recipients. Without financial support of the costly pharmacy clean room, an experienced home infusion pharmacist or the supplies to administer the drug into the patient, coverage of the Part D infusion drug does the Medicare recipient little good.