tci Medicare Compliance & Reimbursement - 2003 Issue 8

Reimbursement: GAO TARGETS NEW AWP PAYMENT HEMORRHAGE

As with most covered drugs and biologicals,Medicare pays way too much for blood clotting factor, the General Accounting Office maintains in a report released Feb. 12. The culprit is familiar: Payment for blood clotting factor — a biological used by hemophiliacs to prevent uncontrolled internal bleeding — is based on the now-notorious “average wholesale price,” a manufacturer-set price some critics have maintained is little more than a fiction. While Medicare pays 95 percent of AWP for clotting factor, the costs for providers is much lower, according to “Medicare: Payment for Blood Clotting Factor Exceeds Providers&rsquo...

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