Medicare officials have approved a bonus payment to encourage the use of a new drug that rapidly reverses warfarin therapy in adults with acute major bleeding.
Starting on Oct. 1, Medicare will provide a maximum add-on payment of $1,587.50 for the use of Kcentra (prothrombin complex concentrate, human) in the inpatient hospital setting. The add-on payment is about 50% of the average cost of the treatment. The add-on payment, which will continue for at least 2 years, will be provided when the cost of care exceeds the Medicare Severity Diagnosis-Related Group (MS-DRG) payment.
Kcentra is a replacement therapy for fresh frozen plasma (FFP) for patients with an acquired coagulation factor deficiency who are experiencing a severe bleed caused by warfarin. The drug’s maker, CSL Behring, said Kcentra is a good alternative for immunoglobulin A–deficient patients who cannot have FFP, as well as for Jehovah’s witnesses and other patients whose religious beliefs prevent them from accepting transfusions of plasma.
Kcentra, which was approved by the Food and Drug Administration in April (2013), is available as a lyophilized powder that must be reconstituted with sterile water prior to administration as an intravenous infusion. It is dosed based on factor IX units.
Medicare approved the bonus payment as part of the "new technology add-on payment policy" first implemented in 2001, which is aimed at ensuring that Medicare beneficiaries have timely access to new, but expensive drugs and devices. The add-on payments are granted for products that are both innovative and inadequately paid for under the Medicare DRG payment system.
In the fiscal year 2014, Inpatient Prospective Payment System rule, published on Aug. 19, Medicare officials wrote that Kcentra is a "substantial clinical improvement over existing technologies" by providing a rapid resolution a patient’s blood clotting deficiency while decreasing the risk of exposure to blood borne pathogens and other transfusion-associated complications.