According to a recently released report from the HHS OIG, pharmacies are reimbursed significantly more for dispensing drugs under Medicare Part B than they would be for dispensing the same drugs under Medicare Part D and Medicaid. The OIG recommended that CMS amend current regulations to decrease Part B payment rates for dispensing and supplying fees to make the rates similar to those under Part D and Medicaid.
In its report, the OIG found that Medicare paid approximately $106 million on dispensing fees and $26 million on supplying fees under Part B in 2011, when it would have paid around $19 million for dispensing fees and $3 million for supplying fees if using Part D rates, and roughly $19 million for dispensing fees and $8 million for supplying fees if Medicaid rates had been used. Medicare Part B pays a dispensing fee for inhalation drugs administered through durable medical equipment, as well as a supplying fee for immunosuppressive drugs associated with organ transplant, oral anticancer chemotherapeutic drugs, and oral antiemetic drugs used as part of an anticancer chemotherapeutic regimen.
CMS did not concur with the OIG’s recommendation to decrease Part B payment rates to amounts similar to those under Part D and Medicaid. Instead, CMS stated that, while the information provided by OIG was useful, “pharmacies that dispense and supply significant amounts of immunosuppressive, oral anticancer, oral antiemetic and inhalation drugs to Medicare beneficiaries have argued that higher fees are necessary to support activities that are associated with dispensing drugs to Medicare patients, such as Part B claim submission or the delivery of inhalation drugs.” CMS suggested that the OIG conduct a study that would “(a) identify the specific activities involved with dispensing inhalation drugs and supplying oral drugs under part B; and (b) collect information about the actual costs directly associated with dispensing these Part B drugs.” Despite the suggestion, the OIG stated that it would not conduct such as study, as such a study was “unlikely to be a useful deployment of Government resources.”