Government

OIG finds Medicare overpayment for drugs

NEWS IN BRIEF — Posted Feb. 16, 2004

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Medicare should revise its payment levels for three physician-administered drugs, the Health and Human Services' Office of Inspector General said. Medicare pays substantially more for albuterol, used to treat asthma and emphysema, and ipratropium bromide, a treatment for chronic bronchitis or emphysema, than do Medicaid programs or the Dept. of Veterans Affairs, the OIG said.

Investigators said that Medicare is expected to pay somewhat higher prices because practitioners must purchase the drugs from pharmacies, while the VA purchases the drugs in bulk. However, they said, the price differential is large enough to be "disconcerting."

The OIG also recommended that the Centers for Medicare & Medicaid Services instruct all carriers to use its least-costly-alternative policy to reduce prices for Lupron. Most carriers will pay no more for a single dose of Lupron than they do for Zoladex, which is considered by many experts to be clinically comparable. But carriers are paying higher prices in 10 of the 57 jurisdictions, the OIG said.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/02/16/gvbf0216.htm.

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