Practice Manager Insider

Opinions Vary on the CAP Interim Final Rule

Before the suspension of the implementation of the Competitive Acquisition Program (CAP), opinions varied as to whether the CAP would help or hurt oncology practices. From the Centers for Medicare & Medicaid Services (CMS), the issuer of the CAP program, Administrator Mark McClellan, MD, PhD, said, “The program frees physicians from the administrative work of purchasing and procuring drugs in their offices, so that they can focus more time and resources on providing the best treatments for their patients.” On the other hand, a primary concern of the Community Oncology Alliance (COA) (Click “here” under COA Reports and findings) was that CAP gives CMS and the CAP vendors too much control over the drug acquisition and billing process. In addition, COA noted that physicians will still need to purchase some drugs using the current “buy and bill” system, and must commit to a year of enrollment in order to participate in CAP. COA concluded that physicians should carefully consider how enrollment in CAP might affect their practice management needs.

What do you think of the CAP program as proposed in the CAP Interim Final Rule? How do you expect CAP, as published, could affect your practice?

Comments on Interim Final Rule for CAP

In comments (click "here" at the bottom of ACCC news release page) submitted April 26, 2005 to Centers for Medicare and Medicaid Services (CMS), the Association of Community Cancer Centers (ACCC) questioned the practical application of the now suspended Competitive Acquisition Plan (CAP) Interim Final Rule that was planned to go into effect January 1, 2006. The implementation of the CAP program will be delayed until the vendor competitive bidding process is re-established. According to the ACCC, the program as presented in the Interim Final Rule would add an administrative burden to physicians that may discourage participation in CAP, causing access to cancer drugs through the program to diminish.  ACCC recommended CMS take steps to both reduce the administrative burden of CAP and provide increased compensation to offset the increase in administrative costs. In addition, ACCC recommended changes of policy regarding the acquisition of drugs from CAP vendors.

Overview of CAP Interim Final Rule

In a news release on June 27, 2005, the Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule that established the now delayed Competitive Acquisition Program (CAP) for the purchasing of Medicare Part B physician injectable drugs. The CAP will be a voluntary program that allows physicians to acquire drugs from vendors who are selected through a competitive bidding process, as opposed to the current “buy and bill” system. Once CMS has published a list of vendors and the drugs they will offer, physicians may then select one vendor, obtaining all available Medicare drugs though that vendor. The vendors would then be responsible for billing Medicare and beneficiaries. The aim of the program is to reduce the time and paperwork associated with direct purchase of drugs, while in the long term reducing drug costs through the competitive bidding of vendors. Physicians will be able to elect to participate in the program once a year. Once CMS has published the CAP Final Rule, physicians can voluntarily enroll.  CMS estimates the program will go into effect by July 2006.

A full copy of the CAP Interim Final is available on the Federal Register website. CMS will accept comments on the CAP Interim Final Rule as published until September 6, 2005. Nonelectronic comments regarding the program may be submitted to CMS by mail: Department of Health and Human Services, Attention: CMS-1325-IFC, PO Box 8013, Baltimore, MD 21244-8013 or by courier at: Room 445-G, Hubert Humphrey Bldg, 200 Independence Ave SW, Washington, DC 20201; or 7500 Security Blvd, Baltimore, MD 21244-1850.

CMS Competitive Acquisition Program Vendor Bidding Process Suspended

Centers for Medicare & Medicaid Services (CMS) has suspended the vendor bidding process for the Competitive Acquisition Program (CAP) established by the Medicare Final Interim Rule announced June 27, 2005, in a CMS news release. Despite the suspension, CMS will further review comments regarding the CAP, and said, “after we are able to analyze the comments and determine how we can best improve the efficiency and attractiveness of the CAP, we anticipate publishing a final rule in late 2005.” Once the final version is published and vendors have been selected, CMS will establish an election period in which doctors will have the opportunity to voluntarily enroll with a specific vendor. CMS expects physicians will be able to obtain drugs through CAP by July 2006.