Practice Manager Insider

How the CAP Vendor Proposes to Fix CAP

The CEO of the sole specialty pharmacy vendor for the Medicare Part B Competitive Acquisition Program (CAP) testified at the July 13 hearing of the House Ways and Means Subcommittee on Health hearing about how to address problems that may account for the very low participation in the program. Only 307 physicians had signed up as of July 10, of whom 18 are medical oncologists.

Richard Friedman, CEO of BioScrip, spent much of his oral testimony summarizing issues with CAP and how to address them. He listed the following barriers and proposed solutions:

• Lack of on-site inventory → Supply physicians’ offices with limited inventory for emergencies


• Must ship to site of drug administration → Permit shipments to multiple locations designated by MDs


• Added MD billing requirements → MDs bill for administrative fee only


• Patient copay concerns → Enable MDs to support copay for beneficiaries on a case-by case basis


• Physician need for education about CAP → Allow MD open enrollment

Only 18 Oncologists Signed Up for CAP?

The recent House Ways and Means Subcommittee on Health hearing about Medicare Part B reimbursement offered a window into the early days of the Competitive Acquisition Program (CAP). This is because the CEO of the specialty medication distribution firm BioScrip, the sole CAP vendor, testified at the hearing. The CAP is a voluntary program that offers physicians the option of obtaining Part B drugs from vendors selected in a competitive bidding process, rather than buying and billing these drugs under the average sales price (ASP) system. Enrollment was extended until June 30 and the program began on July 1.

Some figures in the cancer care community have expressed skepticism about whether oncologists would sign up for the CAP. This view appears to have been well founded. Only 18 medical oncologists had signed up for CAP as of July 10, according to written testimony submitted by Richard Friedman, CEO of BioScrip. A total of 307 physicians in all specialties have registered, he said. Specialties with the largest concentrations of signups are ophthalmology (77) and allergy/immunology (69). However, oncology accounts for the largest share of Part B allowed charges.

Friedman mentioned the need to address issues with the CAP and to educate physicians about the program’s benefits. Testimony from two oncology representatives highlights the daunting nature of those tasks. Joseph S. Bailes, MD, of the American Society of Clinical Oncology (ASCO) mentioned that oncologists may avoid the CAP because CAP vendors can cut off access to drugs for patients who fail to pay their coinsurance within 45 days. Frederick M. Schnell, MD, president of the Community Oncology Alliance, characterized CAP in this way: “The oncology community at large (views) CAP as an untried and untested experiment. We will not expose our patients to the risks it presents. CAP will force the creation of individual patient inventories, increase the likelihood of treatment errors and delays, and place new and unreimbursed administrative burdens on our clinics.”

Deadline for CAP Enrollment Extended to June 30

The Centers for Medicare & Medicaid Services (CMS) approved this extension on May 31, two days before sign-ups had been scheduled to close on June 2. Physicians who sign up during the extension period will begin participation in the Competitive Acquisition Program (CAP) on August 1, 2006. Sign-up is defined as local carrier receipt of physician election forms postmarked no later than June 30, 2006. Implementation of the Competitive Acquisition Program (CAP) for those who have already registered is still scheduled for July 1, 2006. Medicare carriers’ mailing addresses are available on the CMS website. CMS anticipates holding another as-yet unscheduled “Ask the Contractor” call for physicians before the conclusion of the extended physician election period. The date will be posted on the CMS website.

CAP Update: Enroll Until June 2; Join a Teleconference Tomorrow

Practices have from now until June 2 to enroll in Medicare’s Competitive Acquisition Program (CAP). Enrollment opened on May 8. The CAP is a voluntary program that offers physicians the option of obtaining Part B drugs from vendors selected in a competitive bidding process, rather than buying and billing these drugs under the average sales price (ASP) system. The first CAP period covers July 1 through December 31, 2006. Click here for the physician election form to sign up for the CAP. The completed and signed form must be mailed to your local carrier and postmarked on or before June 2, 2006.

The Centers for Medicare & Medicaid Services (CMS) and Noridian Administrative Services (NAS) will host an “Ask the Contractor” teleconference tomorrow offering physicians and their staff an opportunity to learn more about the CAP.

Call details:

      Date: Thursday, May 11, 2006, 1:00-2:30 p.m. EST
      Title: Ask the Contractor Teleconference for CAP
      Call in Number: 1-866-216-6835
      Access Code: 329694

Please dial in 5 minutes prior to conference start time. Enter your access code, followed by the pound (#) sign. Your line will be placed on hold with music until conference start.

CMS chose one vendor to serve the entire country for 2006. BioScrip will supply about 180 drugs to physician offices. Many are used in oncology practices; click here for this list. The vendor pick was announced April 21.

CAP Enrollment Starts April 3, 2006

Physician practices can begin enrolling in the Competitive Acquisition Program (CAP) as of April 3, 2006. By that date, CMS expects to have posted on its website the names of participating CAP vendors for 2006, the categories of drugs that they will provide, and the geographic area in which each vendor will operate. Physicians then can choose the categories of drugs that they wish to receive from each vendor under CAP. Reports indicate that, initially, 182 Part B drugs and biologicals will be included in CAP.

For this first CAP cycle, which is a partial year running from July 1 through December 31, 2006, physicians have until May 18, 2006 to make their selections and there will be one category of drugs and one geographic area. Starting January 2007, the CAP cycle reverts to a calendar-year basis and elections will occur in the fall of each year.

CAP offers physicians the choice of obtaining certain drugs from vendors selected in a competitive bidding process, rather than buying and billing for these medications under the average sales price (ASP) system.