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CMS presents new competitive acquisition program

Physician Practice Advisor, June 29, 2005

Physicians who administer drugs in their offices to Medicare beneficiaries will have the option of participating in a new competitive acquisition program (CAP) beginning Jan. 1, 2006, according to a Centers for Medicare & Medicaid Services (CMS) press release. Under an interim final rule, these physicians will be able to choose to obtain many physician-administered drugs from vendors selected by Medicare through competitive contracting.

"This new competitive approach for Part B drugs aims to give physicians a new and less burdensome option for acquiring the treatments their patients need," said CMS Administrator Mark McClellan, MD, PhD, in the release. "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."

The new program will apply to physician-injectable drugs covered under Medicare's Supplemental Medical Insurance (or Part B) program that are commonly provided incident to the physician's service. It will not apply to drugs included in the new Prescription Drug Benefit under Medicare Part D, which also goes into effect Jan. 1, 2006. Nor will it apply to drugs that are self-administered by the patient through a device such as a nebulizer, or to certain other drugs, such as intravenous immune globulin (IVIG), immunosuppressive drugs, and hemophilia blood clotting factor.

Of approximately 440 drugs that are billed incident to a physician service and paid under Part B, 181 will be included in the CAP, accounting for 85% of all Medicare spending on physician injectable drugs, the CMS press release explained. CMS will evaluate CAP's implementation and use that information to decide whether and how the program will be modified in the future.

For more information about the CAP, click here.

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