CMS Publishes Interim Final Rule for Competitive Acquisition Program (CAP) for Part B Drugs and Biologicals

July 6, 2005 – CMS published an interim final rule for a new competitive acquisition program (CAP) for physician-administered drugs.  Effective January 1, 2006, the CAP would serve as an alternative to the current system where physicians purchase drugs and then are reimbursed at an average sales price (ASP) determined by Medicare.  Physicians who select the new option could obtain most of their most commonly administered Medicare drugs through a vendor that then would be responsible for billing Medicare and beneficiaries for the drug.  Initially two to five national vendors and 169 drugs would be involved.   

In the rule, CMS responded to a number of recommendations made by ASH in our comment letter on the proposed rule, including decisions to:

• Make the program national in scope rather than phasing it in by region or specialty.
• Include most of the drugs that physicians administer to Medicare patients, particularly those that frequently cannot be purchased at the ASP. (The 169 drugs included in the program are responsible for 85% of Medicare spending on physician-administered drugs.)
• Require vendors to create plans for assisting beneficiaries who cannot meet the co-payments for their drugs.

ASH remains concerned about implementation of the new program and the Society will continue to urge CMS to make modifications, particularly reducing the administrative burden associated with participating in the CAP.

ASH will continue to work with other medical societies on the CAP.  We will also put out a detailed analysis of interim final rule and seek input from the Committee on Practice prior to its September 6th deadline.  If you have any questions, please do not hesitate to contact ASH Director of Government Relations & Practice Mila Becker at 202-776-0544. More information is also available on the CMS Website.