Keeping you updated on the latest Medicare and Part D news

Leave a comment

CMS Releases First Installment of Open Payments Data

Today, CMS released the first installment of Open Payments data, listing drug and device companies’ payments to physicians and teaching hospitals during the last five months of 2013. According to the CMS Press Release, “the data contains 4.4 million payments valued at nearly $3.5 billion attributable to 546,000 individual physicians and almost 1,360 teaching hospitals.”

Currently, about 40 percent of records are de-identified due to inconsistent physician information. CMS plans to add additional data as records are corrected, as well as provide tools for users to search and analyze the data. ProPublica released an article detailing several caveats users should keep in mind about the first installment of Open Payments.

The dataset is available at


Leave a comment

OIG Releases Special Advisory Bulletin Against Manufacturer Coupons in Part D

Manufacturer coupons may not be used by beneficiaries of Federal health care programs, but recent surveys found that 6 to 7 percent of seniors reported using manufacturer coupons towards Part D drug copayments. This means that over 2 million beneficiaries could be using copayment coupons for prescriptions paid for by Part D.

The OIG investigated whether pharmaceutical manufacturers employed sufficient safeguards to prevent Part D beneficiaries from using copayment coupons. All surveyed manufacturers provided notices to beneficiaries and pharmacists on at least one of their coupon formats, and most implemented pharmacy claims edits to prevent the coupons from being processed with Part D claims. However, the OIG found notices that were printed in small font and/or provided on separate pages, so they may not be seen by beneficiaries or pharmacists. Furthermore, the surveyed pharmacy claims edits may not accurately identify Part D beneficiaries. For example, some manufacturers based the edit on the beneficiary’s age, which would ignore beneficiaries under 65 who qualify for Part D due to a disability and flag beneficiaries who are over 65 but are not enrolled in Part D. Unfortunately, because it is very difficult to identify the use of copayment coupons within pharmacy claims, Part D plans and oversight entities cannot reliably prevent the use of manufacturer coupons.

The OIG released a Special Advisory Bulletin reminding pharmaceutical manufacturers of their responsibility to distribute coupons in compliance with Federal law. The OIG also recommended that CMS work towards improving the reliability of pharmacy claims edits that prevent the use of copayment coupons, increasing coupon transparency, and making the use of coupons identifiable in pharmacy claims.


OIG Report

Leave a comment

Questionable Prescriptions for Dementia Patients

Last week, CMS announced a new goal to reduce antipsychotic medication use in nursing homes by 25 percent by the end of 2015 and 30 percent by the end of 2016. Antipsychotic medications come with black box warnings, the FDA’s most serious alert, notifying users that the medication can have fatal risks for the elderly and people with dementia. Currently, around 20 percent of long-stay nursing home residents receive antipsychotic medications. Past studies conducted by the OIG and Boston Globe found widespread inappropriate use of antipsychotic medications in nursing homes, including regimens with high dosages and excessive durations, and prescriptions for off-label conditions.

CMS Announcement

A recent study published in the Journal of American Medicine found other questionable prescriptions for nursing home patients with advanced dementia. Within the sample studied, almost 54 percent of patients received a drug that was deemed never appropriate for people with advanced dementia receiving palliative care (e.g., cholesterol medication). Not only do these medications provide little benefit to patients, they also come with a high cost and potential side effects.



Leave a comment

OIG Study Finds Higher Drug Supplying and Dispensing Fees in Part B than Part D and Medicaid

A recent Office of Inspector General (OIG) report analyzed 2011 Medicare Part B spending on dispensing fees for inhalation drugs administered through durable medicare equipment and supplying fees for certain immunosuppressive, anticancer, and antiemetic drugs. Overall, Part B spent almost $133 million on the dispensing and supplying fees for these drugs. The OIG estimated that if Part B had used average Part D payment rates, it would only have spent $22 million on dispensing and supplying fees. Similarly, using average State Medicaid rates, Part B would only have paid $26.6 million.

Ultimately, the OIG recommended that CMS pursue policies bringing Part B payment rates for dispensing and supplying fees closer to those of Part D and Medicaid. CMS did not agree with this recommendation, and requested additional information on the activities and costs associated with providing the studied drugs. The OIG declined to explore the request, maintaining that pharmacists did not identify additional services or requirements for providing these drugs to Part B beneficiaries as opposed to Part D and Medicaid beneficiaries.



Leave a comment

DEA Expands Prescription Drug Take-Back Efforts

The Drug Enforcement Agency (DEA) will soon allow hospitals, drug manufacturers, pharmacies, and other authorized entities to take back prescription controlled substances. These organizations, as well as law enforcement, can voluntarily maintain collection receptacles and administer mail-back programs. Before this change, people could either dispose of unused drugs themselves (which poses environmental concerns), or return them to police stations in one of the DEA’s semi-annual prescription take-back events.