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Hospitals to get new drug payments quicker

Pharmacy Regulation Resource, August 25, 2004

The proposed 2005 Outpatient Prospective Payment System (OPPS) would speed access to new treatments and medications, the Centers for Medicare & Medicaid Services (CMS) announced August 9.

The rule proposes a method for hospitals to receive payment for new drugs and biologicals as soon as the FDA approves them, according to CMS. Hospitals would not have to wait several months until CMS assigns a code and payment rate to receive reimbursement from Medicare.

The proposed rule also continues payments for most drugs that cost more than $50 each time providers give them to patients, CMS said. Prior to the 2004 OPPS and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, those drugs were included in a lump-fee ambulatory payment classification, often causing hospitals to lose money on the drugs.

The rule was published in the August 16 Federal Register. CMS will accept public comments on the rule until October 8, and will publish the final rule by November 1.

Go to www.cms.hhs.gov/regulations/ecomments to submit comments.

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