CMS Lowers 2009 Funding Rates for Outpatient Services

11/18/2008

The Centers for Medicaid & Medicare Services (CMS) approved outpatient medication reimbursement rate for 2009 that may leave pharmacy departments with costly burdens, despite repeated warnings from ASHP.

The Hospital Outpatient Prospective Payment System reimbursement rate for separately paid drugs dropped from an average sales price (ASP) plus 5 percent in 2008 to an ASP plus 4 percent starting January 1. The Society advocated for CMS to set that rate at no less than ASP plus 6 percent so pharmacies could cover costs, particularly those for medication management.

The rule, which applies to all hospital outpatient and ambulatory surgery center services covered by CMS, also includes a payment rate for blood clotting factors of ASP plus 4 percent, and a $60 packaging threshold for drugs and biologicals included in the payment for associated procedure for administered drugs. That rate remained unchanged from 2008.