Starting next month, physicians will have an alternative to billing for Medicare Part B drugs under the average sales price system.
Officials at the Centers for Medicare and Medicaid Services are launching the Competitive Acquisition Program (CAP) for Part B drugs starting on July 1. The new voluntary program will allow physicians to obtain selected Part B drugs from vendors chosen by CMS through a competitive bidding process.
During the initial phase of the program, CMS has selected one vendor—BioScrip—to provide drugs.
Physicians who participate in CAP will be paid for the administration of the Part B drug or biologic on an assignment-related basis, according to CMS, but will not have to take on the financial risk of purchasing the drugs first.
The program should help to cut down on physician paperwork, according to CMS officials, because CAP vendors are responsible for collecting coinsurance and deductibles from Medicare beneficiaries once drug administration is verified. Physicians who participate in the program will submit claims for drug administration services to their local carrier within 14 days and provide their vendor with beneficiary supplemental insurance information.
But the program may not offer the relief being advertised by CMS, some physicians said. Dr. Alfred Denio, a rheumatologist in Norfolk, Va., said CAP could be an alternative in areas where it has not been financially feasible for physicians to purchase infused therapies on their own. However, even going through a CAP vendor, there will be a significant administrative burden, said Dr. Denio, who serves on the American College of Rheumatology's Committee on Rheumatologic Care.
For example, physicians must submit written orders for drugs to the CAP vendor, notify the vendor when a CAP drug is not administered or the full supply was not administered, and maintain a separate electronic or paper inventory for each CAP drug. “That's added cost to the practice that you will not be reimbursed for,” he said.
Although the ACR has not taken an official position on CAP, Dr. Denio said that he believes the administrative burden will be difficult for the office-based physician and that he suspects that few will sign up for the program.
CAP is likely to be a plus for Medicare because it will allow the agency to reduce costs, but there are still not enough details available about the program to ensure that there won't be adverse consequences for physicians, said Dr. Richard Hellman, president-elect of American Association of Clinical Endocrinologists.
Once physicians sign up, they must obtain all drugs on the CAP drug list from their drug vendor, except in certain cases such as emergency administration, according to CMS. This year there are about 180 drugs on the CAP drug list (www.cms.hhs.gov/CompetitiveAcquisforBios/Downloads/CAP_Drugs_List.pdf
It may make sense to obtain some medicines through the CAP vendor, Dr. Hellman said, but physicians will not be able to pick and choose among drugs on the CAP list.
Dr. Hellman said he is also concerned that CAP will affect access to medications if it makes it unprofitable for physicians to deliver these services in their offices. “[CMS officials] need to be careful that they do not restrict access in their zeal to cut costs.”
This year CAP will run from July 1 to Dec. 31. Starting in 2007, the program will run year-round, a 45-day physician election period each fall. Physicians can opt into the CAP program each year and will be required to stay in the program for a full calendar year. More information on the CAP program is available at www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp