Medicare Part B Reimbursement of Prescription Drugs . Endnotes

06/01/2014

1 42 C.F.R. § 405.517.

2 U.S. Department of Health and Human Services, Office of Inspector General, Excessive Medicare Payments for Prescription Drugs, Pub. No. OEI-03-97-00290, 1997.

3 U.S. Department of Health and Human Services, Office of Inspector General, Medicare Reimbursement of Prescription Drugs, Pub. No. OEI-03-00-00310, 2001.

4 U.S. Department of Health and Human Services, Office of Inspector General, Excessive Medicare Reimbursement for Albuterol, Pub. No. OEI-03-01-00410, 2002.

5 U.S. Department of Health and Human Services, Office of Inspector General, Excessive Medicare Reimbursement for Iipratropium Bromide, Pub. No. OEI-03-01-00411, 2002.

6 Medicare Payment Advisory Commission, Chapter 9: Medicare Payments for Outpatient Drugs under Part B, Report to the Congress: Variation and Innovation in Medicare, 2003.

7 U.S. Government Accountability Office, Medicare: Payments for Covered Outpatient Drugs Exceed Providers' Cost, Pub. No. GAO-01-1118, 2001.

8 Congressional Research Service, Medicare: Payments for Covered Prescription Drugs, Pub. No. RL31419, 2002.

9 42 C.F.R. § 405 as amended.

10 42 C.F.R. § 419 as amended. Separately payable drugs are those that are not packaged within an ambulatory payment classification group because their average cost per day of treatment exceeds $80. The Medicare Hospital Outpatient Prospective Payment System (OPPS) has typically reimbursed these drugs at ASP plus a 4 to 6 percent margin.

11 42 U.S.C. § 1395w-3a(c).

12 Mullen P, The Arrival of Average Sales Price," Biotechnology Healthcare 4:48-53, 2007.

13 Arkansas BlueCross and BlueShield, Provider's News: March 2005. Available at: http://www.arkansasbluecross.com/doclib/publications/march_2005.pdf.

14 Appleby J, "A New Way To Pay For Chemotherapy: Major Insurer Would Pay Oncologists A Set Fee For Certain Cancers," Kaiser Health News: October 20, 2010. Available at: http://www.kaiserhealthnews.org/stories/2010/october/20/chemotherapy.aspx.

15 Medicare Payment Advisory Commission, Report to the Congress: Effects of Medicare Payment Changes on Oncology Services, 2006.

16 Medicare Payment Advisory Commission, Report to the Congress: Impact of Changes in Medicare Payments for Part B Drugs, 2007.

17 Jacobson M, Earle CC, Price M, and Newhouse JP, How Medicare's Payment Cuts for Cancer Chemotherapy Drugs Changed Patterns of Treatment, Health Affairs 29(7): 1394-1402, 2010.

18 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Economic Analysis of the Causes of Drug Shortages, 2011.

19 We cannot directly test whether the MMA reduced price volatility because data prior to 2005 are not available.

20 IMS Health, IMS National Sales Perspective™, Data extracted May 2014.

21 IMS Institute for Healthcare Informatics, Medicine Use and Shifting Costs of Healthcare: A Review of the Use of Medicines in the U.S. in 2013, 2014.

22 U.S. Department of Health and Human Services, Office of Inspector General, Medicare Payments for Newly Available Generic Drugs, Pub. No. OEI-03-09-00510, 2011.

 

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