Out of concern for high drug prices, the Department of Health and Human Services Office of Inspector General (OIG) is waiving a portion of a policy designed to avoid the violation of anti-kickback statutes.
The OIG declared that hospital pharmacies may waive charges to Medicare patients who obtain drugs they administer to themselves on an outpatient basis.
"Although some or all of the self-administered drugs a Medicare beneficiary receives in an outpatient setting may be covered by Medicare Part D, most hospital pharmacies do not participate in Medicare Part D," said the OIG rationale. CMS has stated that only hospitals with pharmacies that dispense prescriptions to outpatients and have contracts with Medicare Part D plans should bill the contracted plans directly as in-network pharmacies; otherwise, the hospitals should bill the Medicare beneficiaries.
The OIG decided to put a waiver in place because patients that were being charged were suffering financial hardship, according to Bloomberg BNA.
Under the terms of the waiver, hospitals must not market or advertise the discounts or waivers, and must not shift the cost burden elsewhere within the Medicare or Medicaid programs, or to commercial payers or other individual patients.
The waiver comes as the healthcare sector and its patients struggle with the rising costs of pharmaceuticals, and more Americans take prescription drugs. A recent Aon Hewitt survey concluded that the cost of specialty drugs are projected to rise as much as 23 percent in 2016. And some companies exacerbate the issue by buying up the patents for drugs that have been on the market for decades and jacking up their prices by a factor of more than 50. Some states have responded by placing a cap on individual patients' out-of-pocket costs for drug expenditures.
As a result of many of these trends, the HHS just announced it would convene a public forum to discuss the issue later this month.
To learn more:
- read the Bloomberg BNA article
- check out the OIG policy (.pdf)