tci Medicare Compliance & Reimbursement - 2004 Issue 4

Pharmaceuticals: CMS TACKLES AWP

In one of its first steps towards turning the sprawling Medicare legislation signed by President Bush on Dec. 8 into on-the-ground reality, the Centers for Medicare & Medicaid Services is transforming the way Medicare pays for injectible drugs and other already-covered medications. Currently, Medicare reimburses physicians for these drugs at the lesser of what a physician charges the program or 95 percent of the "average wholesale price." The new rule, published in the Jan. 6 Federal Register, sets the 2004 payment for most covered drugs at 85 percent of the April 1, 2003, AWP, although Medicare will continue...

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