Most commercial insurers have not switched to Medicare’s average sales price (ASP) basis of reimbursement for physician-administered drugs, according to a report in the current issue of Oncology Now, a newsletter published by the Lash Group. Representatives of some physician practices attending local International Oncology Network (ION) conferences note that some payers are moving to ASP-based reimbursement—most commonly ASP plus 12%.
At least three Blue Cross and Blue Shield plans have adopted ASP, according to Oncology Now and Specialty Pharmacy News, Blue Cross and Blue Shield of Nebraska, Blue Cross and Blue Shield of Texas, and Anthem Blue Cross and Blue Shield of Colorado.
Elyse Freeman, RPh, PharmD, and director of private payer strategy at the Lash Group, recommends that practices analyze their costs in preparation for contract negotiations with payers – including treatment administration, pharmacy preparation, and related care management costs. It also is prudent to identify the basis of the payer’s fee schedule (eg, ASP, average wholesale price, etc.).
State Medicaid programs are starting to adopt Medicare’s ASP-plus-6% reimbursement policy, according to Oncology Now. Those who have moved to this formula include Alabama, Michigan, North Carolina, New Mexico, Ohio, Washington, Wisconsin, and West Virginia.
In California, Blue Cross, Blue Shield, and United Healthcare have all moved to an ASP based reimbursement methodology for drugs. In all cases, the ASP-based level of reimbursement was lower.
Posted by: Patricia Falconer, MBA | June 02, 2006 at 06:07 PM