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entitled 'Medicare: Drug Purchase Prices for CMS Consideration in
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June 30, 2005:
The Honorable Michael O. Leavitt:
The Secretary of Health and Human Services:
Subject: Medicare: Drug Purchase Prices for CMS Consideration in
Hospital Outpatient Rate-Setting:
Dear Mr. Secretary:
Medicare pays hospitals for drugs that beneficiaries receive as part of
their treatment in hospital outpatient departments. Specifically, the
Centers for Medicare & Medicaid Services (CMS) in the Department of
Health and Human Services (HHS) uses an outpatient prospective payment
system (OPPS) to pay hospitals fixed, predetermined rates for services.
These services include drugs given to beneficiaries in outpatient
settings. When OPPS was first developed as directed by the Balanced
Budget Act of 1997,[Footnote 1] the rates for hospital outpatient
services and drugs were based on hospitals' 1996 median costs. However,
these rates prompted concerns that payments to hospitals would not
reflect the cost of newly introduced pharmaceutical products--drugs,
biologicals,[Footnote 2] and radiopharmaceuticals[Footnote 3]--used to
treat, for example, cancer, rare blood disorders, and other serious
conditions. In turn, congressional concerns were raised that
beneficiaries might lose access to some of these products if hospitals
avoided providing them because of a perceived shortfall in payments.
In response to these concerns, the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 1999 authorized pass-through
payments, which are a way to augment, on a temporary basis, the OPPS
payments for newly introduced pharmaceutical products first used after
1996.[Footnote 4] The Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) modified this payment method for some
of these pharmaceutical products.[Footnote 5] As part of the
modification, the MMA defined a new payment category--specified covered
outpatient drugs (SCOD)--which includes many of these newly introduced
pharmaceutical products. The MMA defined a SCOD as a drug or
radiopharmaceutical used in hospital outpatient departments, covered by
Medicare, and for which CMS has established a separate ambulatory
payment classification (APC) group.[Footnote 6] In addition to these
criteria, the MMA required that, for a drug to be a SCOD, it must have
been paid for on a pass-through basis on or before December 31, 2002.
The MMA established a methodology for CMS to follow in setting payment
rates for SCODs in 2004 and 2005. The MMA excluded, among other drugs,
orphan drugs--certain drugs or biologicals that are used for rare
diseases and conditions--from being paid as SCODs for 2004 and 2005 and
was not explicit about whether orphan drugs will be SCODs after
2005.[Footnote 7] CMS defines SCODs by their Healthcare Common
Procedure Coding System (HCPCS) codes, which CMS assigns to products,
supplies, and services for billing purposes. Drug HCPCS are categories
that include one or more component drugs with similar chemical
entities. These drugs within a HCPCS can vary by manufacturer,
strength, and package size.
The MMA directed us to collect data on hospital acquisition costs of
SCODs and to provide information based on these data to the Secretary
of Health and Human Services for his consideration in setting 2006
Medicare payment rates.[Footnote 8] The MMA directed us to collect
these data by surveying a large sample of hospitals.
In summary, we obtained from our survey data the average and median
purchase prices for each of 53 SCOD drug categories. We report purchase
price information for those SCOD categories containing more than one
drug. Purchase pricerefers to the price that hospitals pay upon
receiving the product and is the key component of hospital acquisition
costs. The 53 SCOD categories represent 86 percent of all Medicare
spending on SCODS in the first 9 months of 2004. The purchase price
information takes account of discounts taken at the time hospitals
received the product but excludes any rebates paid to hospitals
subsequent to the receipt of the product.
Scope and Methodology:
This report presents results drawn from our survey data on 53 SCOD
categories for the period July 1, 2003, through June 30, 2004.[Footnote
9] These 53 SCOD categories represented 86 percent of Medicare spending
for SCODs during the first 9 months of 2004.[Footnote 10] We report the
average and median purchase prices for the SCOD categories containing
more than one drug; we do not include purchase price information where
there is only one drug in a category because of the potential
proprietary sensitivity of such information.[Footnote 11] The purchase
price information takes account of volume and other discounts, but it
excludes rebates, which manufacturers may give after a hospital has
paid for the drugs, and payments made to hospitals by group purchasing
organizations, which negotiate prices with manufacturers on behalf of
their member hospitals. In a subsequent report, we will provide
information on the radiopharmaceuticals that constituted an additional
9 percent of Medicare spending on SCODs during the first 9 months of
2004. These two reports together provide purchase price information on
SCODs that accounted for 95 percent of all Medicare spending on SCODs
during the first 9 months of 2004.
To produce average and median purchase prices, we conducted a survey of
1,400 acute care, Medicare-certified hospitals,[Footnote 12] expecting
that this would yield responses from about 1,000 hospitals.[Footnote
13] We conducted the survey from September 27, 2004, through February
22, 2005, and received usable information from 1,157 hospitals, which
gave us a response rate of 83 percent. We asked the hospitals to
provide price data for SCODs purchased from July 1, 2003, through June
30, 2004. Using our survey data, we calculated average and median
purchase prices. To ensure the soundness of our approach to data
collection and analysis, we obtained comments from an advisory panel of
experts in pharmaceutical economics, pharmacy, medicine, survey
sampling, and Medicare payment. To assess the reliability of our data,
we checked for anomalies and outliers, asked hospitals for
clarification as needed, and discussed technical issues with a hospital
pharmacist. On this basis, we determined that the data were
sufficiently reliable for our purposes. (For details on our methods,
see enc. I.)
Our results have certain limitations. First, despite a high survey
response rate and a large sample size, our estimates of average and
median purchase prices are more precise for drugs that were purchased
by many hospitals than for drugs that were purchased by relatively few
hospitals. Second, we limited our detailed results to hospitals'
purchase prices because we could not fully account for rebates or
payments from group purchasing organizations. Third, the average and
median purchase prices we report refer to a specific time period and
might have increased or decreased since then. We performed our work
according to generally accepted government auditing standards from
March 2004 through June 2005.
Hospitals' Acquisition Costs:
for Selected SCOD Categories:
The following section presents detailed information on purchase prices-
-the key component of hospitals' acquisition costs--for certain SCOD
categories[Footnote 14] for the period July 1, 2003, through June 30,
2004. We also present limited information on rebates, another component
of acquisition costs.
Table 1 contains information on average and median purchase prices. We
order the SCOD categories by their rank in Medicare spending for drug
SCODs and have identified the SCOD categories by their HCPCS
codes.[Footnote 15] These SCOD categories accounted for 86 percent of
all Medicare spending on SCODs for the period January 1 through
September 30, 2004. For each SCOD category with more than one drug, we
present both the average and the median purchase prices, as well as
other information that provides context, including the CMS payment rate
and average sales price (ASP). The CMS payment rate is the payment rate
specified for each HCPCS for 2005, and ASP is the average price for a
drug based on a manufacturer's sales to all purchasers in the United
States, with certain exceptions.
Table 1: Purchase Prices for Drugs Accounting for 86 Percent of
Medicare Spending on SCODs:
Rank in Medicare spending on drug SCODs: 1;
HCPCS code: Q0136;
Description: Injection, Epoetin Alpha (for non-ESRD use), per 1,000
units;
Medicare spending on SCOD, 2004[A] (in millions): $199.8;
% of Medicare spending on SCODs, 2004[B]: 10.1;
Number of hospitals in sample: 973;
Total number of hospitals[C]: 2,758;
CMS payment rate for 2005[D]: $11.09;
ASP (average sales price)[E]: $9.25;
Average purchase price[F]: $9.74;
95% confidence interval of the average purchase price[G]: $9.55-9.94;
Median purchase price[H]: $10.12;
95% confidence interval of the median purchase price[G]: $10.11- 10.13.
Rank in Medicare spending on drug SCODs: 2;
HCPCS code: J9310;
Description: Rituximab, 100 mg;
Medicare spending on SCOD, 2004[A] (in millions): $158.4;
% of Medicare spending on SCODs, 2004[B]: 8.0;
Number of hospitals in sample: 871;
Total number of hospitals[C]: 1,418;
CMS payment rate for 2005[D]: $437.83;
ASP (average sales price)[E]: $414.92;
Average purchase price[F]: $412.31;
95% confidence interval of the average purchase price[G]: $407.43-
417.20;
Median purchase price[H]: $412.30;
95% confidence interval of the median purchase price[G]: $412.13-
412.52.
Rank in Medicare spending on drug SCODs: 3;
HCPCS code: J2505;
Description: Injection, Pegfilgrastim, 6 mg;
Medicare spending on SCOD, 2004[A] (in millions): $144.8;
% of Medicare spending on SCODs, 2004[B]: 7.3;
Number of hospitals in sample: 759;
Total number of hospitals[C]: 1,177;
CMS payment rate for 2005[D]: $2,448.50;
ASP (average sales price)[E]: $2,017.55;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 4[J];
HCPCS code: Q9941;
Description: Injection, Immune Globulin, Intravenous, Lyophilized, 1 g;
Medicare spending on SCOD, 2004[A] (in millions): [K];
% of Medicare spending on SCODs, 2004[B]: [K];
Number of hospitals in sample: 626;
Total number of hospitals[C]: [L];
CMS payment rate for 2005[D]: $80.68;
ASP (average sales price)[E]: $36.54;
Average purchase price[F]: $36.50;
95% confidence interval of the average purchase price[G]: $36.37-36.63;
Median purchase price[H]: $37.24;
95% confidence interval of the median purchase price[G]: $37.15-37.24.
Rank in Medicare spending on drug SCODs: 4[J];
HCPCS code: Q9943;
Description: Injection, Immune Globulin, Intravenous, Non-Lyophilized,
1 g;
Medicare spending on SCOD, 2004[A] (in millions): [K];
% of Medicare spending on SCODs, 2004[B]: [K];
Number of hospitals in sample: 281;
Total number of hospitals[C]: [L];
CMS payment rate for 2005[D]: $80.68;
ASP (average sales price)[E]: $53.04;
Average purchase price[F]: $50.63;
95% confidence interval of the average purchase price[G]: $50.11-51.15;
Median purchase price[H]: $50.96;
95% confidence interval of the median purchase price[G]: $50.96- 52.06.
Rank in Medicare spending on drug SCODs: 5;
HCPCS code: J1745;
Description: Injection, Infliximab, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $114.8;
% of Medicare spending on SCODs, 2004[B]: 5.8;
Number of hospitals in sample: 897;
Total number of hospitals[C]: 1,903;
CMS payment rate for 2005[D]: $57.40;
ASP (average sales price)[E]: $50.20;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 6;
HCPCS code: Q0137;
Description: Injection, Darbepoetin alfa, 1 mcg (non-ESRD use);
Medicare spending on SCOD, 2004[A] (in millions): $100.6;
% of Medicare spending on SCODs, 2004[B]: 5.1;
Number of hospitals in sample: 743;
Total number of hospitals[C]: 1,117;
CMS payment rate for 2005[D]: $3.66;
ASP (average sales price)[E]: $3.04;
Average purchase price[F]: $3.00;
95% confidence interval of the average purchase price[G]: $2.95-3.05;
Median purchase price[H]: $3.09;
95% confidence interval of the median purchase price[G]: $3.06-3.11.
Rank in Medicare spending on drug SCODs: 7;
HCPCS code: J9170;
Description: Docetaxel, 20 mg;
Medicare spending on SCOD, 2004[A] (in millions): $73.7;
% of Medicare spending on SCODs, 2004[B]: 3.7;
Number of hospitals in sample: 829;
Total number of hospitals[C]: 1,257;
CMS payment rate for 2005[D]: $312.69;
ASP (average sales price)[E]: $278.95;
Average purchase price[F]: $295.03;
95% confidence interval of the average purchase price[G]: $294.10-
295.96;
Median purchase price[H]: $294.61;
95% confidence interval of the median purchase price[G]: $294.46-
294.89.
Rank in Medicare spending on drug SCODs: 8;
HCPCS code: J9045;
Description: Carboplatin, 50 mg;
Medicare spending on SCOD, 2004[A] (in millions): $70.7;
% of Medicare spending on SCODs, 2004[B]: 3.6;
Number of hospitals in sample: 893;
Total number of hospitals[C]: 1,482;
CMS payment rate for 2005[D]: $129.96;
ASP (average sales price)[E]: $71.46;
Average purchase price[F]: $132.10;
95% confidence interval of the average purchase price[G]: $131.65-
132.55;
Median purchase price[H]: $132.69;
95% confidence interval of the median purchase price[G]: $132.55-
132.83.
Rank in Medicare spending on drug SCODs: 9;
HCPCS code: C9205;
Description: Injection, Oxaliplatin, per 5 mg;
Medicare spending on SCOD, 2004[A] (in millions): $67.0;
% of Medicare spending on SCODs, 2004[B]: 3.4;
Number of hospitals in sample: 708;
Total number of hospitals[C]: 1,172;
CMS payment rate for 2005[D]: $82.53;
ASP (average sales price)[E]: $77.86;
Average purchase price[F]: $75.91;
95% confidence interval of the average purchase price[G]: $74.90-76.91;
Median purchase price[H]: $77.69;
95% confidence interval of the median purchase price[G]: $77.65-77.76.
Rank in Medicare spending on drug SCODs: 10;
HCPCS code: J3487;
Description: Injection, Zoledronic Acid, 1 mg;
Medicare spending on SCOD, 2004[A] (in millions): $66.9;
% of Medicare spending on SCODs, 2004[B]: 3.4;
Number of hospitals in sample: 862;
Total number of hospitals[C]: 1,316;
CMS payment rate for 2005[D]: $197.87;
ASP (average sales price)[E]: $187.47;
Average purchase price[F]: $185.27;
95% confidence interval of the average purchase price[G]: $183.71-
186.83;
Median purchase price[H]: $190.67;
95% confidence interval of the median purchase price[G]: $190.26-
191.01.
Rank in Medicare spending on drug SCODs: 11;
HCPCS code: J9201;
Description: Gemcitabine Hcl, 200 mg;
Medicare spending on SCOD, 2004[A] (in millions): $55.0;
% of Medicare spending on SCODs, 2004[B]: 2.8;
Number of hospitals in sample: 855;
Total number of hospitals[C]: 1,317;
CMS payment rate for 2005[D]: $105.73;
ASP (average sales price)[E]: $108.79;
Average purchase price[F]: $105.69;
95% confidence interval of the average purchase price[G]: $105.13-
106.24;
Median purchase price[H]: $106.54;
95% confidence interval of the median purchase price[G]: $106.44-
106.65.
Rank in Medicare spending on drug SCODs: 12;
HCPCS code: J9206;
Description: Irinotecan, 20 mg;
Medicare spending on SCOD, 2004[A] (in millions): $39.4;
% of Medicare spending on SCODs, 2004[B]: 2.0;
Number of hospitals in sample: 786;
Total number of hospitals[C]: 1,109;
CMS payment rate for 2005[D]: $127.33;
ASP (average sales price)[E]: $119.56;
Average purchase price[F]: $116.31;
95% confidence interval of the average purchase price[G]: $113.87-
118.75;
Median purchase price[H]: $122.67;
95% confidence interval of the median purchase price[G]: $122.16-
123.13.
Rank in Medicare spending on drug SCODs: 13;
HCPCS code: J2324;
Description: Injection, Nesiritide, 0.25 mg;
Medicare spending on SCOD, 2004[A] (in millions): $37.6;
% of Medicare spending on SCODs, 2004[B]: 1.9;
Number of hospitals in sample: 892;
Total number of hospitals[C]: 1,619;
CMS payment rate for 2005[D]: $66.23;
ASP (average sales price)[E]: $69.64;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 14;
HCPCS code: J9265;
Description: Paclitaxel, 30 mg;
Medicare spending on SCOD, 2004[A] (in millions): $32.0;
% of Medicare spending on SCODs, 2004[B]: 1.6;
Number of hospitals in sample: 792;
Total number of hospitals[C]: 1,398;
CMS payment rate for 2005[D]: $79.04;
ASP (average sales price)[E]: $17.70;
Average purchase price[F]: $14.45;
95% confidence interval of the average purchase price[G]: $14.44-14.46;
Median purchase price[H]: $14.45;
95% confidence interval of the median purchase price[G]: $14.45-21.34.
Rank in Medicare spending on drug SCODs: 15;
HCPCS code: J9355;
Description: Trastuzumab, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $31.4;
% of Medicare spending on SCODs, 2004[B]: 1.6;
Number of hospitals in sample: 679;
Total number of hospitals[C]: 1,089;
CMS payment rate for 2005[D]: $50.79;
ASP (average sales price)[E]: $49.99;
Average purchase price[F]: $46.72;
95% confidence interval of the average purchase price[G]: $45.92-47.53;
Median purchase price[H]: $47.97;
95% confidence interval of the median purchase price[G]: $47.93-48.04.
Rank in Medicare spending on drug SCODs: 16;
HCPCS code: J9217;
Description: Leuprolide Acetate (for depot suspension), 7.5 mg;
Medicare spending on SCOD, 2004[A] (in millions): $30.8;
% of Medicare spending on SCODs, 2004[B]: 1.6;
Number of hospitals in sample: 804;
Total number of hospitals[C]: 1,319;
CMS payment rate for 2005[D]: $543.72;
ASP (average sales price)[E]: $213.83;
Average purchase price[F]: $234.05;
95% confidence interval of the average purchase price[G]: $223.21-
244.90;
Median purchase price[H]: $198.88;
95% confidence interval of the median purchase price[G]: $195.83-
215.41.
Rank in Medicare spending on drug SCODs: 17;
HCPCS code: J0256;
Description: Injection, Alpha 1 - Proteinase Inhibitor - Human, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $20.9;
% of Medicare spending on SCODs, 2004[B]: 1.1;
Number of hospitals in sample: 38;
Total number of hospitals[C]: 279;
CMS payment rate for 2005[D]: $3.72;
ASP (average sales price)[E]: $3.06;
Average purchase price[F]: $2.35;
95% confidence interval of the average purchase price[G]: $2.33-2.37;
Median purchase price[H]: $2.46;
95% confidence interval of the median purchase price[G]: $2.27-2.46.
Rank in Medicare spending on drug SCODs: 18;
HCPCS code: J9035[M];
Description: Injection, Bevacizumab, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $19.8;
% of Medicare spending on SCODs, 2004[B]: 1.0;
Number of hospitals in sample: 436;
Total number of hospitals[C]: 916;
CMS payment rate for 2005[D]: $57.11;
ASP (average sales price)[E]: $53.88;
Average purchase price[F]: $53.31;
95% confidence interval of the average purchase price[G]: $53.01-53.61;
Median purchase price[H]: $53.72;
95% confidence interval of the median purchase price[G]: $53.69-53.75.
Rank in Medicare spending on drug SCODs: 19;
HCPCS code: J1441;
Description: Injection, Filgrastim (G-CSF), 480 mcg;
Medicare spending on SCOD, 2004[A] (in millions): $17.1;
% of Medicare spending on SCODs, 2004[B]: 0.9;
Number of hospitals in sample: 928;
Total number of hospitals[C]: 1,679;
CMS payment rate for 2005[D]: $274.40;
ASP (average sales price)[E]: $261.46;
Average purchase price[F]: $257.21;
95% confidence interval of the average purchase price[G]: $253.46-
260.96;
Median purchase price[H]: $253.64;
95% confidence interval of the median purchase price[G]: $253.45-
253.78.
Rank in Medicare spending on drug SCODs: 20;
HCPCS code: J1950;
Description: Injection, Leuprolide Acetate (for depot suspension), per
3.75 mg;
Medicare spending on SCOD, 2004[A] (in millions): $16.9;
% of Medicare spending on SCODs, 2004[B]: 0.9;
Number of hospitals in sample: 541;
Total number of hospitals[C]: 904;
CMS payment rate for 2005[D]: $451.98;
ASP (average sales price)[E]: $409.18;
Average purchase price[F]: $454.10;
95% confidence interval of the average purchase price[G]: $453.04-
455.17;
Median purchase price[H]: $454.66;
95% confidence interval of the median purchase price[G]: $454.03-
455.72.
Rank in Medicare spending on drug SCODs: 21;
HCPCS code: J9001;
Description: Doxorubicin Hydrochloride, all lipid formulations, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $16.3;
% of Medicare spending on SCODs, 2004[B]: 0.8;
Number of hospitals in sample: 614;
Total number of hospitals[C]: 955;
CMS payment rate for 2005[D]: $343.78;
ASP (average sales price)[E]: $338.66;
Average purchase price[F]: $336.33;
95% confidence interval of the average purchase price[G]: $332.22-
340.44;
Median purchase price[H]: $338.70;
95% confidence interval of the median purchase price[G]: $338.28-
338.97.
Rank in Medicare spending on drug SCODs: 22;
HCPCS code: J2353;
Description: Injection, Octreotide, depot form for intramuscular
injection, 1 mg;
Medicare spending on SCOD, 2004[A] (in millions): $15.7;
% of Medicare spending on SCODs, 2004[B]: 0.8;
Number of hospitals in sample: 545;
Total number of hospitals[C]: 852;
CMS payment rate for 2005[D]: $69.44;
ASP (average sales price)[E]: $80.95;
Average purchase price[F]: $71.13;
95% confidence interval of the average purchase price[G]: $69.63-72.62;
Median purchase price[H]: $74.04;
95% confidence interval of the median purchase price[G]: $73.54-74.87.
Rank in Medicare spending on drug SCODs: 23;
HCPCS code: J9055[M];
Description: Injection, Cetuximab, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $15.1;
% of Medicare spending on SCODs, 2004[B]: 0.8;
Number of hospitals in sample: 286;
Total number of hospitals[C]: 506;
CMS payment rate for 2005[D]: $49.66;
ASP (average sales price)[E]: $46.85;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 24;
HCPCS code: J9041[M];
Description: Injection, Bortezomib, 0.1 mg;
Medicare spending on SCOD, 2004[A] (in millions): $14.1;
% of Medicare spending on SCODs, 2004[B]: 0.7;
Number of hospitals in sample: 452;
Total number of hospitals[C]: 631;
CMS payment rate for 2005[D]: $28.38;
ASP (average sales price)[E]: $26.77;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 25;
HCPCS code: J9350;
Description: Topotecan, 4 mg;
Medicare spending on SCOD, 2004[A] (in millions): $13.9;
% of Medicare spending on SCODs, 2004[B]: 0.7;
Number of hospitals in sample: 585;
Total number of hospitals[C]: 858;
CMS payment rate for 2005[D]: $697.76;
ASP (average sales price)[E]: $699.75;
Average purchase price[F]: $674.91;
95% confidence interval of the average purchase price[G]: $656.60-
693.21;
Median purchase price[H]: $709.19;
95% confidence interval of the median purchase price[G]: $706.34-
710.50.
Rank in Medicare spending on drug SCODs: 26;
HCPCS code: J1440;
Description: Injection, Filgrastim (G-CSF), 300 mcg;
Medicare spending on SCOD, 2004[A] (in millions): $13.0;
% of Medicare spending on SCODs, 2004[B]: 0.7;
Number of hospitals in sample: 956;
Total number of hospitals[C]: 1,914;
CMS payment rate for 2005[D]: $162.41;
ASP (average sales price)[E]: $165.23;
Average purchase price[F]: $161.61;
95% confidence interval of the average purchase price[G]: $156.81-
166.42;
Median purchase price[H]: $159.18;
95% confidence interval of the median purchase price[G]: $159.04-
159.31.
Rank in Medicare spending on drug SCODs: 27;
HCPCS code: J1785;
Description: Injection, Imiglucerase, per unit;
Medicare spending on SCOD, 2004[A] (in millions): $12.9;
% of Medicare spending on SCODs, 2004[B]: 0.7;
Number of hospitals in sample: 41;
Total number of hospitals[C]: 59;
CMS payment rate for 2005[D]: $3.91;
ASP (average sales price)[E]: $3.69;
Average purchase price[F]: $3.62;
95% confidence interval of the average purchase price[G]: $3.60-3.64;
Median purchase price[H]: $3.62;
95% confidence interval of the median purchase price[G]: $3.61-3.66.
Rank in Medicare spending on drug SCODs: 28;
HCPCS code: J3396;
Description: Injection, Verteporfin, 0.1 mg;
Medicare spending on SCOD, 2004[A] (in millions): $12.3;
% of Medicare spending on SCODs, 2004[B]: 0.6;
Number of hospitals in sample: 10;
Total number of hospitals[C]: 45;
CMS payment rate for 2005[D]: $8.49;
ASP (average sales price)[E]: $8.48;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 29;
HCPCS code: J9202;
Description: Goserelin Acetate Implant, per 3.6 mg;
Medicare spending on SCOD, 2004[A] (in millions): $11.4;
% of Medicare spending on SCODs, 2004[B]: 0.6;
Number of hospitals in sample: 392;
Total number of hospitals[C]: 529;
CMS payment rate for 2005[D]: $390.09;
ASP (average sales price)[E]: $181.78;
Average purchase price[F]: $201.76;
95% confidence interval of the average purchase price[G]: $193.30-
210.23;
Median purchase price[H]: $206.56;
95% confidence interval of the median purchase price[G]: $175.73-
323.33.
Rank in Medicare spending on drug SCODs: 30;
HCPCS code: J1626;
Description: Injection, Granisetron Hydrochloride, 100 mcg;
Medicare spending on SCOD, 2004[A] (in millions): $11.1;
% of Medicare spending on SCODs, 2004[B]: 0.6;
Number of hospitals in sample: 682;
Total number of hospitals[C]: 988;
CMS payment rate for 2005[D]: $16.20;
ASP (average sales price)[E]: $6.71;
Average purchase price[F]: $6.45;
95% confidence interval of the average purchase price[G]: $6.27-6.62;
Median purchase price[H]: $6.61;
95% confidence interval of the median purchase price[G]: $6.60-6.64.
Rank in Medicare spending on drug SCODs: 31;
HCPCS code: J0585;
Description: Botulinim Toxin Type A, per unit;
Medicare spending on SCOD, 2004[A] (in millions): $10.8;
% of Medicare spending on SCODs, 2004[B]: 0.5;
Number of hospitals in sample: 480;
Total number of hospitals[C]: 1,062;
CMS payment rate for 2005[D]: $4.32;
ASP (average sales price)[E]: $4.44;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 32;
HCPCS code: J0207;
Description: Injection, Amifostine, 500 mg;
Medicare spending on SCOD, 2004[A] (in millions): $10.5;
% of Medicare spending on SCODs, 2004[B]: 0.5;
Number of hospitals in sample: 477;
Total number of hospitals[C]: 705;
CMS payment rate for 2005[D]: $395.75;
ASP (average sales price)[E]: $403.84;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 33;
HCPCS code: J2430;
Description: Injection, Pamidronate Disodium, per 30 mg;
Medicare spending on SCOD, 2004[A] (in millions): $10.2;
% of Medicare spending on SCODs, 2004[B]: 0.5;
Number of hospitals in sample: 945;
Total number of hospitals[C]: 1,567;
CMS payment rate for 2005[D]: $128.74;
ASP (average sales price)[E]: $54.10;
Average purchase price[F]: $58.49;
95% confidence interval of the average purchase price[G]: $51.51-65.47;
Median purchase price[H]: $72.59;
95% confidence interval of the median purchase price[G]: $71.50-72.72.
Rank in Medicare spending on drug SCODs: 34;
HCPCS code: J9390;
Description: Vinorelbine Tartrate, per 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $9.3;
% of Medicare spending on SCODs, 2004[B]: 0.5;
Number of hospitals in sample: 568;
Total number of hospitals[C]: 833;
CMS payment rate for 2005[D]: $52.78;
ASP (average sales price)[E]: $58.20;
Average purchase price[F]: $48.15;
95% confidence interval of the average purchase price[G]: $48.13-48.16;
Median purchase price[H]: $48.14;
95% confidence interval of the median purchase price[G]: $48.13-52.05.
Rank in Medicare spending on drug SCODs: 35;
HCPCS code: J2993;
Description: Injection, Reteplase, 18.1 mg;
Medicare spending on SCOD, 2004[A] (in millions): $8.9;
% of Medicare spending on SCODs, 2004[B]: 0.4;
Number of hospitals in sample: 505;
Total number of hospitals[C]: 1,073;
CMS payment rate for 2005[D]: $1,192.09;
ASP (average sales price)[E]: $832.49;
Average purchase price[F]: $846.53;
95% confidence interval of the average purchase price[G]: $844.18-
848.87;
Median purchase price[H]: $845.36;
95% confidence interval of the median purchase price[G]: $844.48-
846.87.
Rank in Medicare spending on drug SCODs: 36;
HCPCS code: J9293;
Description: Injection, Mitoxantrone Hydrochloride, per 5 mg;
Medicare spending on SCOD, 2004[A] (in millions): $8.4;
% of Medicare spending on SCODs, 2004[B]: 0.4;
Number of hospitals in sample: 672;
Total number of hospitals[C]: 1,181;
CMS payment rate for 2005[D]: $313.96;
ASP (average sales price)[E]: $305.36;
Average purchase price[F]: $297.00;
95% confidence interval of the average purchase price[G]: $296.19-
297.82;
Median purchase price[H]: $295.62;
95% confidence interval of the median purchase price[G]: $295.46-
295.78.
Rank in Medicare spending on drug SCODs: 37;
HCPCS code: J9185;
Description: Fludarabine Phosphate, 50 mg;
Medicare spending on SCOD, 2004[A] (in millions): $7.6;
% of Medicare spending on SCODs, 2004[B]: 0.4;
Number of hospitals in sample: 669;
Total number of hospitals[C]: 891;
CMS payment rate for 2005[D]: $311.09;
ASP (average sales price)[E]: $243.05;
Average purchase price[F]: $293.99;
95% confidence interval of the average purchase price[G]: $291.43-
296.56;
Median purchase price[H]: $298.44;
95% confidence interval of the median purchase price[G]: $298.37-
298.68.
Rank in Medicare spending on drug SCODs: 38;
HCPCS code: C1305;
Description: Apligraf[®], per 44 square centimeters;
Medicare spending on SCOD, 2004[A] (in millions): $7.0;
% of Medicare spending on SCODs, 2004[B]: 0.4;
Number of hospitals in sample: 63;
Total number of hospitals[C]: 450;
CMS payment rate for 2005[D]: $1,130.88;
ASP (average sales price)[E]: $1,114.74;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 39;
HCPCS code: J9395;
Description: Injection, Fulvestrant, 25 mg;
Medicare spending on SCOD, 2004[A] (in millions): $6.9;
% of Medicare spending on SCODs, 2004[B]: 0.3;
Number of hospitals in sample: 468;
Total number of hospitals[C]: 778;
CMS payment rate for 2005[D]: $79.65;
ASP (average sales price)[E]: $76.78;
Average purchase price[F]: $74.63;
95% confidence interval of the average purchase price[G]: $74.45-74.80;
Median purchase price[H]: $75.03;
95% confidence interval of the median purchase price[G]: $74.95-75.18.
Rank in Medicare spending on drug SCODs: 40;
HCPCS code: J3100;
Description: Injection, Tenecteplase, 50 mg;
Medicare spending on SCOD, 2004[A] (in millions): $6.8;
% of Medicare spending on SCODs, 2004[B]: 0.3;
Number of hospitals in sample: 509;
Total number of hospitals[C]: 1,181;
CMS payment rate for 2005[D]: $2,350.98;
ASP (average sales price)[E]: $1,901.29;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 41;
HCPCS code: J9305[M];
Description: Injection, Pemetrexed, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $5.6;
% of Medicare spending on SCODs, 2004[B]: 0.3;
Number of hospitals in sample: 162;
Total number of hospitals[C]: 251;
CMS payment rate for 2005[D]: $40.54;
ASP (average sales price)[E]: $38.25;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 42;
HCPCS code: J9160;
Description: Denileukin Diftitox, 300 mcg;
Medicare spending on SCOD, 2004[A] (in millions): $5.6;
% of Medicare spending on SCODs, 2004[B]: 0.3;
Number of hospitals in sample: 73;
Total number of hospitals[C]: 95;
CMS payment rate for 2005[D]: $1,438.80;
ASP (average sales price)[E]: $1,144.18;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 43;
HCPCS code: J0180[M];
Description: Injection, Agalsidase Beta, 1 mg;
Medicare spending on SCOD, 2004[A] (in millions): $5.3;
% of Medicare spending on SCODs, 2004[B]: 0.3;
Number of hospitals in sample: 29;
Total number of hospitals[C]: 49;
CMS payment rate for 2005[D]: $121.11;
ASP (average sales price)[E]: $114.26;
Average purchase price[F]: $111.33;
95% confidence interval of the average purchase price[G]: $111.08-
111.58;
Median purchase price[H]: $109.71;
95% confidence interval of the median purchase price[G]: $108.18-
111.09.
Rank in Medicare spending on drug SCODs: 44;
HCPCS code: Q0166;
Description: Granisetron Hydrochloride, 1 mg, oral[N];
Medicare spending on SCOD, 2004[A] (in millions): $4.8;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 541;
Total number of hospitals[C]: 886;
CMS payment rate for 2005[D]: $39.04;
ASP (average sales price)[E]: $31.04;
Average purchase price[F]: $24.86;
95% confidence interval of the average purchase price[G]: $24.82-24.89;
Median purchase price[H]: $23.99;
95% confidence interval of the median purchase price[G]: $21.58-24.94.
Rank in Medicare spending on drug SCODs: 45;
HCPCS code: J2469[M];
Description: Injection, Palonosetron Hcl, 25 mcg;
Medicare spending on SCOD, 2004[A] (in millions): $4.6;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 295;
Total number of hospitals[C]: 525;
CMS payment rate for 2005[D]: $18.09;
ASP (average sales price)[E]: $17.06;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 46;
HCPCS code: J9010;
Description: Alemtuzumab, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $4.4;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 236;
Total number of hospitals[C]: 356;
CMS payment rate for 2005[D]: $541.46;
ASP (average sales price)[E]: $478.73;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 47[O];
HCPCS code: Q9942;
Description: Injection, Immune Globulin, Intravenous, Lyophilized, 10
mg;
Medicare spending on SCOD, 2004[A] (in millions): [P];
% of Medicare spending on SCODs, 2004[B]: [P];
Number of hospitals in sample: 626;
Total number of hospitals[C]: [Q];
CMS payment rate for 2005[D]: $0.75;
ASP (average sales price)[E]: $0.37;
Average purchase price[F]: $0.37;
95% confidence interval of the average purchase price[G]: $0.36-0.37;
Median purchase price[H]: $0.37;
95% confidence interval of the median purchase price[G]: $0.37-0.37.
Rank in Medicare spending on drug SCODs: 47[O];
HCPCS code: Q9944;
Description: Injection, Immune Globulin, Intravenous, Non- Lyophilized,
10 mg;
Medicare spending on SCOD, 2004[A] (in millions): [P];
% of Medicare spending on SCODs, 2004[B]: [P];
Number of hospitals in sample: 281;
Total number of hospitals[C]: [Q];
CMS payment rate for 2005[D]: $0.75;
ASP (average sales price)[E]: $0.53;
Average purchase price[F]: $0.51;
95% confidence interval of the average purchase price[G]: $0.50-0.51;
Median purchase price[H]: $0.51;
95% confidence interval of the median purchase price[G]: $0.51-0.52.
Rank in Medicare spending on drug SCODs: 48;
HCPCS code: J7190;
Description: Factor VIII (Antihemophilic Factor, Human) per I.U;
Medicare spending on SCOD, 2004[A] (in millions): $4.2;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 55;
Total number of hospitals[C]: 122;
CMS payment rate for 2005[D]: $0.76;
ASP (average sales price)[E]: $0.60;
Average purchase price[F]: $0.46;
95% confidence interval of the average purchase price[G]: $0.46-0.46;
Median purchase price[H]: $0.46;
95% confidence interval of the median purchase price[G]: [R].
Rank in Medicare spending on drug SCODs: 49;
HCPCS code: J0130;
Description: Injection, Abciximab, 10 mg;
Medicare spending on SCOD, 2004[A] (in millions): $4.0;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 570;
Total number of hospitals[C]: 797;
CMS payment rate for 2005[D]: $448.22;
ASP (average sales price)[E]: $417.35;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 50;
HCPCS code: J0850;
Description: Injection, Cytomegalovirus Immune Globulin Intravenous
(Human), per vial;
Medicare spending on SCOD, 2004[A] (in millions): $3.8;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 156;
Total number of hospitals[C]: 260;
CMS payment rate for 2005[D]: $622.13;
ASP (average sales price)[E]: $632.67;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Rank in Medicare spending on drug SCODs: 51;
HCPCS code: J1327;
Description: Injection, Eptifibatide, 5 mg;
Medicare spending on SCOD, 2004[A] (in millions): $3.7;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 911;
Total number of hospitals[C]: 1,661;
CMS payment rate for 2005[D]: $11.21;
ASP (average sales price)[E]: $11.79;
Average purchase price[F]: $12.49;
95% confidence interval of the average purchase price[G]: $12.35-12.63;
Median purchase price[H]: $11.03;
95% confidence interval of the median purchase price[G]: $10.75-12.39.
Rank in Medicare spending on drug SCODs: 52;
HCPCS code: J9214;
Description: Interferon, Alfa-2B, Recombinant, 1 million units;
Medicare spending on SCOD, 2004[A] (in millions): $3.6;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 619;
Total number of hospitals[C]: 954;
CMS payment rate for 2005[D]: $13.00;
ASP (average sales price)[E]: $12.25;
Average purchase price[F]: $11.20;
95% confidence interval of the average purchase price[G]: $11.02-11.37;
Median purchase price[H]: $11.93;
95% confidence interval of the median purchase price[G]: $11.78-11.98.
Rank in Medicare spending on drug SCODs: 53;
HCPCS code: C9201;
Description: Dermagraft[®], per 37.5 square centimeters;
Medicare spending on SCOD, 2004[A] (in millions): $3.4;
% of Medicare spending on SCODs, 2004[B]: 0.2;
Number of hospitals in sample: 2;
Total number of hospitals[C]: 80;
CMS payment rate for 2005[D]: $529.54;
ASP (average sales price)[E]: $545.10;
Average purchase price[F]: [I];
95% confidence interval of the average purchase price[G]: [I];
Median purchase price[H]: [I];
95% confidence interval of the median purchase price[G]: [I].
Source: GAO survey and CMS.
Notes: ESRD = end-stage renal disease, g = gram, I.U. = international
unit, mcg = microgram, and mg = milligram.
[A] Medicare spending is for the period January 1, 2004, through
September 30, 2004.
[B] The percentage of Medicare spending is based on Medicare spending
for all SCODs--both drugs and radiopharmaceuticals.
[C] This estimate of the total number of hospitals in the population is
based on our sample.
[D] This is the payment rate specified for each HCPCS for 2005. It
incorporates CMS's April 2005 update.
[E] CMS publishes the ASP plus 6 percent for certain drugs used in
physicians' offices. These amounts are based on data provided by
manufacturers each quarter. We are reporting ASPs for the quarter
beginning in April 2005. ASPs reported here do not include the 6
percent added by CMS.
[F] This price is based on data provided by the hospitals in our survey
and does not reflect any other costs associated with purchasing or
administering the product. We asked hospitals to report prices for
drugs purchased from July 1, 2003, through June 30, 2004. We weighted
the prices by the volume purchased as well as by the sample weights. We
have excluded prices under the 340B program, a federal program that
provides drug price discounts for certain health care entities,
including those that provide health care services for low-income
individuals and individuals in medically underserved areas. (42 U.S.C.
§ 256b (2000)).
[G] The confidence interval measures the precision of the estimate. The
narrower the interval, the greater the precision.
[H] The median purchase price is the midpoint of all prices reported by
hospitals in our sample. Half of the prices reported by hospitals are
above the median and half are below. The median is weighted by volume
purchased and by hospital sample weights. The average purchase price
excludes prices paid under the 340B program.
[I] For HCPCS codes that contain only one National Drug Code (NDC), we
do not include information on the average or median purchase price
because of the potential proprietary sensitivity of such information.
[J] On April 1, 2005, CMS replaced J1563, Injection, Immune Globulin,
Intravenous, 1g, with two new codes: Q9941 and Q9943. J1563 was ranked
fourth in total Medicare spending on SCODs from January 1, 2004, to
September 30, 2004.
[K] J1563, Injection, Immune Globulin, Intravenous, 1g, accounted for
$127.1 million in Medicare spending from January 1, 2004, through
September 30, 2004, which was 6.4 percent of total Medicare spending on
SCODs for that time period.
[L] On April 1, 2005, CMS replaced J1563, Injection, Immune Globulin,
Intravenous, 1g, with two new codes: Q9941 and Q9943. Because J1563 was
replaced by two codes, we could not estimate the total number of
hospitals in the population for these new codes individually.
[M] On January 1, 2005, CMS replaced C9214, C9215, C9207, C9213, C9208,
and C9210 with J9035, J9055, J9041, J9305, J0180, and J2469,
respectively. The ranks for the new codes correspond to the ranks in
total Medicare spending on SCODs from January 1, 2004, to September 30,
2004, for the former codes.
[N] The complete description for HCPCS Q0166 is "Granisetron
Hydrochloride, 1 mg, Oral, Food and Drug Administration (FDA) Approved
Prescription Anti-Emetic, for Use as a Complete Therapeutic Substitute
for an IV (intravenous) Anti-Emetic at the Time of Chemotherapy
Treatment, Not to Exceed a 24 Hour Dosage Regimen."
[O] On April 1, 2005, CMS replaced J1564, Injection, Immune Globulin,
Intravenous, 10 mg, with two new codes: Q9942 and Q9944. J1564 was
ranked 47th in total Medicare spending on SCODs from January 1, 2004,
to September 30, 2004.
[P] J1564, Injection, Immune Globulin, Intravenous, 10 mg accounted for
$4.4 million in Medicare spending from January 1, 2004, through
September 30, 2004, which was 0.2 percent of total Medicare spending on
SCODs for that time period.
[Q] On April 1, 2005, CMS replaced J1564, Injection, Immune Globulin,
Intravenous, 10 mg, with two new codes: Q9942 and Q9944. Because J1564
was replaced by two codes, we could not estimate the total number of
hospitals in the population for these new codes individually.
[R] For this SCOD, our sample data cannot be extrapolated to compute a
confidence interval for the median.
[End of table]
In contrast to the detailed purchase price information in table 1, our
information on the rebate component of hospitals' acquisition costs is
limited. Nearly 60 percent of our sample hospitals reported receiving
one or more rebates. Over half of those hospitals received one or more
rebates for a specific SCOD category, while the others received rebates
for a set of drugs (and sometimes other products). In the latter case,
it is generally not feasible to allocate rebates to specific drugs.
Rebates were not spread uniformly across SCOD categories. For example,
for 14 SCOD categories, no hospital reported receiving a rebate. For
nearly all other SCOD categories, rebates were reported by a small
number of hospitals. However, the effect of rebates on hospital
acquisition costs may be significant for some hospitals purchasing
certain drugs. For one high-volume drug, rebates were reported by one-
fifth of all hospitals that purchased drugs in at least one SCOD
category. For some hospitals, these rebates were as high as 29 percent
of the drug's purchase price. Averaged over all hospitals, rebates for
this drug relative to its purchase price were likely to be considerably
smaller, since most hospitals did not report receiving large rebates.
Agency Comments and Our Evaluation:
We received comments on a draft of this report from HHS (see enc. III).
HHS commended our efforts and acknowledged the challenges of accurately
surveying hospitals for drug acquisition costs. HHS also stated that it
had concerns regarding the limitations of our study. For example, HHS
cited the difficulties that hospitals had in attributing rebates from
manufacturers and payments from group purchasing organizations to
hospitals' purchases of individual drug products. In addition, HHS
anticipated concerns that purchase prices of drugs might have changed
after the sample period for which we collected price data. HHS stated
that it would take account of our data on hospital purchase prices in
developing 2006 Medicare payment rates for SCODs. HHS added that, in
developing payment rates for 2006 and future years, it considered it
important to have a methodology that can be updated appropriately and
that reflects rebates and other components of drug acquisition costs.
Despite the limitations that CMS noted, we believe our estimates of
average purchase price for each SCOD category that we report are
sufficiently accurate for use in developing Medicare rates for SCOD
categories. Moreover, these data are the only publicly available source
of information on what hospitals are paying for these drugs. As HHS
pointed out, our draft report indicated that the lack of comprehensive
rebate data was a limitation of our study. However, hospitals reported
no rebates for 14 of the 53 SCOD categories. In addition, we found
that, for nearly all other SCOD categories, rebates were reported by a
small number of hospitals; consequently, the effect of rebates on
acquisition cost averaged across all hospitals is likely to be small.
We have revised the report to clarify this point. While we believe that
purchase price is currently an adequate measure of hospitals'
acquisition costs, this measure could be improved by adjusting purchase
price for rebates if a different rebate data source or estimating
method were available. HHS also expressed concerns about whether our
data are sufficiently current for use in Medicare rate-setting. If HHS
uses our purchase price data in developing SCOD payment rates, it can
mitigate the effect of time lags by adjusting drug purchase prices in
line with the expected increase or decrease in hospital drug prices for
the coming year. HHS regularly uses a similar approach in other payment
systems, including the hospital inpatient payment system.
We are sending copies of this report to the Senate Committee on
Finance, the House Committee on Energy and Commerce, and the House
Committee on Ways and Means. We will also make copies available to
others on request. The report is available at no charge on GAO's Web
site at http://www.gao.gov.
If you or your staff have any questions about this report, please call
me at (202) 512-7119. Another contact and key contributors are listed
in enclosure IV.
Sincerely yours,
Signed by:
A. Bruce Steinwald:
Enclosures - 4:
Enclosure I: Methodology:
This enclosure summarizes the sample design, methods for conducting the
survey and processing data submissions, and the methods we used for
estimating average and median drug purchase prices of specified covered
outpatient drugs (SCOD). It also names the members of the advisory
panel that commented on our approach to data collection and analysis.
We did our work in accordance with generally accepted government
auditing standards from March 2004 through June 2005.
Sample Design:
We developed a stratified random sample of hospitals. The population
consisted of 3,450 hospitals (1) that had charged Medicare for SCODs
during the first half of 2003 and (2) that were still Medicare
providers on July 1, 2004. To achieve a sample of 1,000 hospitals,
which we determined would meet the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003's (MMA) requirement for a
large sample, we drew a sample of 1,400 hospitals from the population,
on the basis of an expected response rate of 71 percent. A pilot sample
of 48 hospitals was included in the 1,400.
To improve the precision of our estimates of average and median
purchase price, we stratified the sample of hospitals. The objective
was to select strata that would represent very different average
purchase prices for SCODs. Because we did not have a measure of
purchase price at the time we selected the sample, we used total
hospital outpatient drug charges to Medicare as a proxy for purchase
price. We used a regression model to identify stratification factors
(such as teaching hospital status) that would maximize the difference
in average purchase price (as proxied by Medicare charges) among
strata. We selected the strata of hospitals as follows. First, we
grouped them into major teaching hospital, nonmajor teaching hospital,
urban nonteaching hospital, and rural nonteaching hospital strata.
Second, within each of these strata, we further divided the hospitals
into several strata depending on the number of unique SCODs that the
hospitals billed for. For example, one stratum contains major teaching
hospitals that billed for fewer than 20 unique SCODs. Third, we placed
small hospitals in a separate stratum to ensure that hospitals with no
or minimal charges for SCODs during the first 6 months of 2003 were
appropriately represented.[Footnote 16]
In our sample design, we defined a major teaching hospital as a
hospital for which the ratio of residents to the average number of
patients was at least 1 to 4 and a nonmajor teaching hospital as one
having a ratio of residents to patients of less than 1 to 4. We defined
an urban hospital as one located in a county that was considered a
metropolitan statistical area (as defined by the Office of Management
and Budget) and a rural hospital as one located in a county that was
not considered a metropolitan statistical area. We defined a small
hospital as a hospital for which the total charge amount to Medicare
for SCODs during the first 6 months of 2003 was less than $10,000. The
number of unique SCODs refers to the number of SCODs for which each
hospital submitted Medicare claims during the first 6 months of 2003.
(See table 2.)
Table 2: Characteristics of Sample Strata:
Major teaching hospitals:
Stratum: < 20 unique SCODs;
Hospitals in the population[A]: 75;
Average total charges[B]: $238,949;
Standard deviation of total charges[C]: $320,349;
Neyman allocation for total sample of 1,400[D]: 21;
Target sample of 1,000[E]: 11;
Target response rate in %[F]: 52.
Stratum: 20-39 unique SCODs;
Hospitals in the population[A]: 111;
Average total charges[B]: $861,415;
Standard deviation of total charges[C]: $1,805,586;
Neyman allocation for total sample of 1,400[D]: 111;
Target sample of 1,000[E]: 96;
Target response rate in %[F]: 86.
Stratum: 40-59 unique SCODs;
Hospitals in the population[A]: 96;
Average total charges[B]: $2,297,626;
Standard deviation of total charges[C]: $1,985,026;
Neyman allocation for total sample of 1,400[D]: 96;
Target sample of 1,000[E]: 91;
Target response rate in %[F]: 95.
Stratum: 60+ unique SCODs;
Hospitals in the population[A]: 73;
Average total charges[B]: $6,034,849;
Standard deviation of total charges[C]: $3,703,998;
Neyman allocation for total sample of 1,400[D]: 73;
Target sample of 1,000[E]: 73;
Target response rate in %[F]: 100.
Nonmajor teaching hospitals:
Stratum: < 20 unique SCODs;
Hospitals in the population[A]: 143;
Average total charges[B]: $196,875;
Standard deviation of total charges[C]: $241,523;
Neyman allocation for total sample of 1,400[D]: 29;
Target sample of 1,000[E]: 16;
Target response rate in %[F]: 55.
Stratum: 20-39 unique SCODs;
Hospitals in the population[A]: 313;
Average total charges[B]: $714,043;
Standard deviation of total charges[C]: $630,105;
Neyman allocation for total sample of 1,400[D]: 151;
Target sample of 1,000[E]: 94;
Target response rate in %[F]: 62.
Stratum: 40-59 unique SCODs;
Hospitals in the population[A]: 137;
Average total charges[B]: $1,952,405;
Standard deviation of total charges[C]: $1,222,357;
Neyman allocation for total sample of 1,400[D]: 129;
Target sample of 1,000[E]: 80;
Target response rate in %[F]: 62.
Stratum: 60+ unique SCODs;
Hospitals in the population[A]: 34;
Average total charges[B]: $5,242,311;
Standard deviation of total charges[C]: $3,410,652;
Neyman allocation for total sample of 1,400[D]: 34;
Target sample of 1,000[E]: 34;
Target response rate in %[F]: 100.
Urban nonteaching hospitals:
Stratum: < 20 unique SCODs;
Hospitals in the population[A]: 609;
Average total charges[B]: $161,797;
Standard deviation of total charges[C]: $210,080;
Neyman allocation for total sample of 1,400[D]: 99;
Target sample of 1,000[E]: 61;
Target response rate in %[F]: 62.
Stratum: 20-39 unique SCODs;
Hospitals in the population[A]: 428;
Average total charges[B]: $735,416;
Standard deviation of total charges[C]: $728,106;
Neyman allocation for total sample of 1,400[D]: 238;
Target sample of 1,000[E]: 149;
Target response rate in %[F]: 63.
Stratum: 40+ unique SCODs;
Hospitals in the population[A]: 126;
Average total charges[B]: $2,232,851;
Standard deviation of total charges[C]: $1,837,833;
Neyman allocation for total sample of 1,400[D]: 126;
Target sample of 1,000[E]: 110;
Target response rate in %[F]: 87.
Rural nonteaching hospitals:
Stratum: < 20 unique SCODs;
Hospitals in the population[A]: 730;
Average total charges[B]: $136,618;
Standard deviation of total charges[C]: $141,370;
Neyman allocation for total sample of 1,400[D]: 80;
Target sample of 1,000[E]: 49;
Target response rate in %[F]: 61.
Stratum: 20-39 unique SCODs;
Hospitals in the population[A]: 321;
Average total charges[B]: $672,290;
Standard deviation of total charges[C]: $560,202;
Neyman allocation for total sample of 1,400[D]: 140;
Target sample of 1,000[E]: 86;
Target response rate in %[F]: 61.
Stratum: 40+ unique SCODs;
Hospitals in the population[A]: 53;
Average total charges[B]: $2,072,873;
Standard deviation of total charges[C]: $1,382,985;
Neyman allocation for total sample of 1,400[D]: 53;
Target sample of 1,000[E]: 35;
Target response rate in %[F]: 66.
Stratum: Small hospitals;
Hospitals in the population[A]: 201;
Average total charges[B]: $3,679;
Standard deviation of total charges[C]: $3,116;
Neyman allocation for total sample of 1,400[D]: 20;
Target sample of 1,000[E]: 15;
Target response rate in %[F]: 75.
Stratum: Total;
Hospitals in the population[A]: 3,450;
Neyman allocation for total sample of 1,400[D]: 1,400;
Target sample of 1,000[E]: 1,000;
Target response rate in %[F]: 71.
Source: GAO.
[A] Hospitals in the population refers to the number of hospitals that
made any claims to Medicare for outpatient drugs from January 1, 2003,
through June 30, 2003, and were still Medicare-certified hospitals on
July 1, 2004.
[B] Total charges are the hospital outpatient charges to Medicare from
January 1, 2003, through June 30, 2003. Average total charges are
average total charges per hospital.
[C] The standard deviation is a measure of variation around the
average.
[D] The Neyman allocation is a method for determining the optimum
sample size, that is, the sample size that results in the greatest
precision.
[E] We expected an achieved sample of 1,000 (an overall response rate
of 71 percent), and we applied the Neyman allocation to determine the
optimum number of hospitals in each stratum. In some strata, the
optimum allocation exceeded the number of hospitals in the population.
In these instances, the excess hospitals were reallocated to the
remaining strata according to the Neyman allocation.
[F] The target response rate is the ratio of the target sample to the
total sample for each stratum.
[End of table]
To determine whether we had selected strata that represented
substantially different average purchase prices for SCODs, we examined
other possible stratification factors and compared the efficiency of
our stratified sample with a simple random sample.[Footnote 17] Other
factors that we examined included hospital size (measured by both
annual discharges and average number of patients), ownership status
(for-profit, nonprofit), whether the hospital billed Medicare for
radiopharmaceuticals, and whether the hospital billed Medicare for
blood products. However, these other factors were highly correlated
with the factors that we had selected and did not significantly improve
the model. Stratification made the sample about 10 times more efficient
than a simple random sample.
To determine the appropriate number of hospitals in each stratum, we
used the Neyman allocation--a method for determining the optimum sample
size, that is, the sample size that results in the greatest precision.
After the sample was selected, we established the optimal allocation of
1,000 hospitals--our target response--among strata, using another
Neyman allocation. We used the results of this second allocation to
establish target response rates by stratum.
Data Collection and Data Processing:
We developed a survey instrument and tested it before sending it to the
entire sample of 1,400 hospitals. We gave hospitals several options for
submitting data, which we extracted from their submissions and put in a
standard format.
After consulting a number of experts, including pharmacists, hospital
administrators, and representatives from industry groups, on methods of
developing and administering the survey, we developed and pretested the
survey instrument with 12 hospitals in June 2004. This initial
instrument was limited to 22 products. As a result of responses to the
pretest, we modified the data collection instrument, and Westat, our
data collection contractor, piloted the revised instrument with 48
hospitals beginning on August 5, 2004. As a result of the pilot, we
clarified certain instructions and made changes in our procedures but
did not significantly change the instrument.
Westat began data collection from the 1,352 hospitals in the sample on
September 27, 2004.[Footnote 18] Key components of the data collection
protocol were as follows:
* a first mailing to the chief executive officer or chief financial
officer of each hospital explaining the survey, followed by a telephone
call to identify the main point of contact;
* a second mailing to the main contact outlining the data that were
needed and describing the options for submitting the data;
* a follow-up telephone call to facilitate the main contact's
understanding of the data collection, provide technical assistance as
needed, and obtain some basic information about the hospital, such as
whether the hospital participated in the 340B program; and:
* telephone calls at regular intervals to remind the hospitals to
submit their data and to provide assistance as needed.
Hospitals could submit data in one of three ways: by uploading
electronic files through the study Web site, by sending an e-mail to
the study address with data attached, or by sending electronic media or
paper submissions through the mail. Electronic submissions took three
forms: downloads from distributors' ordering and order management
systems,[Footnote 19] extracts from hospitals' own databases, and
entries made in a worksheet form we supplied. Paper submissions were
most often copies of invoices.
The contractor performed extensive follow-up. On average, Westat
interviewers called each hospital 8 times before receiving a complete
data submission. Hospitals that were late in responding received 15
calls, on average. Follow-up calls were most extensive for hospitals in
strata with high target response rates. We obtained an overall response
rate of 83 percent and met our target response rate in 11 of 15 strata.
(See table 3.)
Table 3: Target and Actual Response Rates by Stratum:
Stratum.
Major teaching hospitals:
< 20 unique SCODs;
Target response rate in %: 52;
Actual response rate[A] in %: 71.
20-39 unique SCODs;
Target response rate in %: 86;
Actual response rate[A] in %: 82[B].
40-59 unique SCODs;
Target response rate in %: 95;
Actual response rate[A] in %: 79[B].
60+ unique SCODs;
Target response rate in %: 100;
Actual response rate[A] in %: 85[B].
Nonmajor teaching hospitals:
< 20 unique SCODs;
Target response rate in %: 55;
Actual response rate[A] in %: 79.
20-39 unique SCODs;
Target response rate in %: 62;
Actual response rate[A] in %: 84.
40-59 unique SCODs;
Target response rate in %: 62;
Actual response rate[A] in %: 88.
60+ unique SCODs;
Target response rate in %: 100;
Actual response rate[A] in %: 85[B].
Urban nonteaching hospitals:
< 20 unique SCODs;
Target response rate in %: 62;
Actual response rate[A] in %: 80.
20-39 unique SCODs;
Target response rate in %: 63;
Actual response rate[A] in %: 84.
40+ unique SCODs;
Target response rate in %: 87;
Actual response rate[A] in %: 90[B].
Rural nonteaching hospitals:
< 20 unique SCODs;
Target response rate in %: 61;
Actual response rate[A] in %: 66.
20-39 unique SCODs;
Target response rate in %: 61;
Actual response rate[A] in %: 81.
40+ unique SCODs;
Target response rate in %: 66;
Actual response rate[A] in %: 85.
Small hospitals;
Target response rate in %: 75;
Actual response rate[A] in %: 80.
Total;
Target response rate in %: 71;
Actual response rate[A] in %: 83.
Source: GAO.
[A] Except where otherwise indicated, we counted as responses all
hospitals that sent usable data on or before January 15, 2005.
[B] We continued to process data received through February 22, 2005,
for strata where we had not yet reached our target response rate as of
January 15, 2005.
[End of table]
We extracted data from hospitals' submissions and placed those data in
a standard format for analysis. In many cases, hospitals submitted data
on all drugs purchased--not just SCODs--and consequently we needed to
extract the SCOD data. Most data were submitted for periods of a day or
a month, as we requested, but 106 hospitals submitted annual data,
which we also accepted.
Westat technical staff checked the data for consistency and
completeness and followed up with 71 hospitals to resolve specific
issues. We trimmed the data to exclude outliers. On average, 2.6
percent of purchase records were excluded.
Estimates of SCOD Average and Median Purchase Prices:
This section describes the rationale and method for weighting the
hospital sample data, calculating average purchase price, calculating
median purchase price, and calculating their confidence intervals.
Weighting the Hospital Sample Data:
To estimate hospitals' average and median purchase prices for SCODs,
the sample hospitals' purchase price data are weighted to make them
representative of the population of hospitals from which the sample is
drawn. A survey sample is drawn from a population. To enable data from
the sample to represent data from the population on purchase prices and
other variables, the sample data are weighted: the less likely that a
hospital will be sampled, the larger its weight. For example, if each
hospital has a 1 in 10 probability of being sampled, its sample weight
is 10. That is, each hospital in the sample represents 10 hospitals in
the population. Consequently, if 5 hospitals in a sample buy a
particular drug, and the sample weight is 10, we estimate that 50
hospitals in the population bought that drug. In this report, we refer
to sample weights as "hospital weights." Our sample is stratified, so
all hospitals in a particular stratum (for example, major teaching
hospitals) have the same weight. Since in our sample the probability of
a hospital's being selected varied by stratum, hospitals in different
strata have different weights.
In calculating weights, we took account of two distinctive facts about
our survey: First, our sample is unusual in that we must treat it as a
set of separate samples--one for each SCOD--since the population of
hospitals that buy a drug or radiopharmaceutical in a particular HCPCS
varies depending on the SCOD. Some SCODs are bought by many hospitals,
while others are bought by relatively few hospitals. Second, we lacked
a direct measure of the number of hospitals in the population that
bought a particular SCOD; consequently, we used the number of hospitals
that billed for that SCOD, according to Medicare outpatient claims
data, as a proxy or indirect measure of the population's size.
We calculated the hospital weight as:
Wjh = Njh/Rjh
where:
Wjh denotes the hospital weight for the jth SCOD in the hth stratum,
Njh denotes the population (the total number of hospitals) that,
according to Medicare outpatient claims, billed for the jth SCOD in the
hth stratum, and:
Rjh denotes the total number of hospitals in the hth stratum that
purchased the jth SCOD, according to their survey submissions.
This weight recognizes that not all hospitals responded to our survey,
since the weight's denominator is Rjh--the number of hospitals that
responded to the survey and indicated that they bought the jth
drug.[Footnote 20]
We made one adjustment to the hospital weight to take account of
unusual circumstances. In some cases, the total number of hospitals in
a stratum that reported purchasing a particular SCOD exceeded our
population estimates. This situation resulted from imperfections in the
Medicare claims data used as a proxy for purchase price. That is, in
these cases Rjh exceeds Njh. Since that situation is implausible, we
adjusted the size of the population derived from Medicare claims, as
follows:
N'jh = Njh * Rjh/Mjh
where:
N'jh denotes the adjusted population and:
Mjh represents the number of hospitals in the hth stratum that
purchased the jth SCOD, according to their survey submissions, and that
submitted an outpatient claim to Medicare for that drug.
This adjustment makes the size of the adjusted population larger than
the unadjusted population--the number of hospitals that billed Medicare
for the drug. Sampling statisticians call this adjustment "post-
stratification."
Average Purchase Price Using Volume and Hospital Weights:
To summarize hospitals' purchase prices for each SCOD--reflecting
purchases made, in many cases, at different prices and in different
quantities--we calculated an average purchase price for each SCOD. This
average purchase price for a particular SCOD is in effect a weighted
average. To reflect the differences among hospitals in purchase prices
and purchase volumes, we used both the hospital weights and purchase
volume as weighting variables in estimating the average purchase price.
The average purchase price is estimated from our sample data, based on
the following equation:
Yj = (Sigma h Nh/nh Sigma I Y*jhi) / (Sigma h Nh/nh Sigma i X*jhi)
where:
Nh represents the total number of hospitals in the hth stratum,
nh represents the size of the sample of hospitals in the hth stratum,
y*jhi = Sigma k Yjhik , which represents the total dollar amount of the
jth SCOD purchased by the ith hospital in the hth stratum, and:
x*jhi = Sigma k Xjhik , which represents the total number of units of
the jth SCOD purchased by the ith hospital in the hth stratum.
The equation estimates the average purchase price of a SCOD as the
ratio of the total amount purchased in dollars to the total number of
units purchased. For example, a total purchase amount of $50,000 and a
total number of units purchased of 1,000 milligrams yields an average
purchase price of $50 per milligram.
Median Purchase Price Using Volume and Hospital Weights:
In addition to the average purchase price, we calculated the estimated
median of each SCOD's purchase price. To calculate this median, we
first applied volume and hospital weights to each hospital's purchases
of a given SCOD; we then ranked the weighted hospitals' purchase prices
from lowest to highest and selected the midpoint of these prices.
More precisely, the estimated median--based on the population
cumulative density function F for hospital purchase prices--is given
by:
X0.5 = inf {Yjhik: F(Yjhik) greater than or equal to 0.5 } ,
where:
X0.5 denotes the median estimate of hospital purchase price for a
particular SCOD,
Yjhik denotes the unit purchase price listed in the kth invoice record
submitted in our survey by the ith hospital in the hth stratum,
F, the cumulative density function, is the probability that the
variable Y takes on a value less than or equal to a particular value
(in this case, Yjhik),
inf { a:b } refers to the minimum value of a, which satisfies the
condition specified in b (in this case b is the condition that F(yjhik
) greater than or equal to 0.5), and:
the estimated population cumulative density function, F, is defined as:
F(x) = { Sigma h Nh/nh Sigma i Sigma k I(Yjhik less than or equal to x)
} / { Sigma h Nh/nh Sigma i Sigma k }
In this equation for F(x), the hospital weights, Nh/nh, enter in both
the numerator and the denominator. The term I (yjhik less than or equal
to x) equals 1 if yjhik is less than or equal to x and is zero
otherwise; that is, if the purchase price of a SCOD by a hospital in
the hth stratum is less than or equal to x (any specific value), this
term takes on the value of 1.
Confidence Intervals for Average Purchase Price:
and Median Purchase Price:
To help assess the precision of our estimates of average and median
purchase prices, we calculated confidence intervals for each measure. A
confidence interval gives an estimated range of values, calculated from
sample data (our survey), that is likely to include the true average of
the population (in this case, the average purchase price for a
particular SCOD). As is commonly done, we calculated 95 percent
confidence intervals.[Footnote 21] The narrower the confidence interval
around the average calculated from sample data, the more precise the
estimated average is considered to be.
We obtained the 95 percent confidence intervals of our estimated
average purchase prices by using methods detailed in Cochran[Footnote
22] and Hansen, Hurwitz, and Madow,[Footnote 23] since our estimates
were calculated from our survey--that is, from a stratified
sample.[Footnote 24] To calculate the confidence interval for our
estimates of median prices, we used the equations presented in
Binder[Footnote 25] and Francisco and Fuller.[Footnote 26] We estimated
the average purchase prices, median purchase prices, and the confidence
intervals of both these averages and medians using specialized software
for survey data analysis--SUDAAN®.[Footnote 27]
Advisory Panel:
To provide us with advice on our methodology for collecting and
analyzing acquisition cost data concerning SCODs, we convened a panel
of experts with experience in pharmaceutical issues or in technical
fields relevant to our survey. The panel met twice: first, to consult
with us on sample design and the survey, and later to review our
preliminary results. The panelists included the chairman, Joseph P.
Newhouse, PhD--John D. MacArthur Professor of Health Policy and
Management, Harvard University; Robert A. Berenson, MD--Senior Fellow,
Urban Institute; Ernst R. Berndt, PhD--Professor of Applied Economics,
Sloan School of Management, Massachusetts Institute of Technology;
Andrea G. Hershey, PharmD--Clinical Coordinator, Pharmacy Residency
Program Director, Union Memorial Hospital (Baltimore, Md.); and Richard
L. Valliant, PhD--Senior Research Scientist, University of Michigan.
[End of section]
Enclosure II: Naional Drug Codes and Their Names, Grouped by HCPCS:
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0302-01;
National Drug Code name: Procrit[®] 2,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0302-02;
National Drug Code name: Procrit[®] 2,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0303-01;
National Drug Code name: Procrit[®] 3,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0303-02;
National Drug Code name: Procrit[®] 3,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0304-01;
National Drug Code name: Procrit[®] 4,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0304-02;
National Drug Code name: Procrit[®] 4,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0310-01;
National Drug Code name: Procrit[®] 10,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0310-02;
National Drug Code name: Procrit[®] 10,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0312-01;
National Drug Code name: Procrit[®] 10,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0320-01;
National Drug Code name: Procrit[®] 20,000 unit/mL.
Rank in Medicare spending on drug SCODs: 1;
HCPCS and description: Q0136, Injection, Epoetin Alpha (for non-ESRD
use), per 1,000 units;
National Drug Code: 59676-0340-01;
National Drug Code name: Procrit[®] 40,000 unit/mL.
Rank in Medicare spending on drug SCODs: 2;
HCPCS and description: J9310, Rituximab, 100 mg;
National Drug Code: 50242-0051-21;
National Drug Code name: Rituxan[®] 10 mg/mL.
Rank in Medicare spending on drug SCODs: 2;
HCPCS and description: J9310, Rituximab, 100 mg;
National Drug Code: 50242-0053-06;
National Drug Code name: Rituxan[®] 10 mg/mL.
Rank in Medicare spending on drug SCODs: 3;
HCPCS and description: J2505, Injection, Pegfilgrastim, 6 mg;
National Drug Code: 55513-0190-01;
National Drug Code name: Neulasta[®] 6 mg/0.6 mL.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00053-7486-05;
National Drug Code name: Gammar[®] -P IV 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00053-7486-06;
National Drug Code name: Gammar[®] -P IV 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00053-7486-10;
National Drug Code name: Gammar[®] -P IV 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00078-0124-96;
National Drug Code name: Sandoglobulin[®] 6 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00944-2620-01;
National Drug Code name: Gammagard[®] S/D 0.5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00944-2620-02;
National Drug Code name: Gammagard[®] S/D 2.5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00944-2620-03;
National Drug Code name: Gammagard[®] S/D 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 00944-2620-04;
National Drug Code name: Gammagard[®] S/D 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 44206-0416-03;
National Drug Code name: Carimune[®] NF 3 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 44206-0417-06;
National Drug Code name: Carimune[®] NF 6 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 44206-0418-12;
National Drug Code name: Carimune[®] NF 12 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 44206-0505-51;
National Drug Code name: Carimune[®] 1 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 44206-0507-56;
National Drug Code name: Carimune[®] 6 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 44206-0508-62;
National Drug Code name: Carimune[®] 12 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0268-66;
National Drug Code name: Panglobulin[®] 6 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0269-72;
National Drug Code name: Panglobulin[®] 12 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0417-06;
National Drug Code name: Panglobulin[®] NF 6 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0417-12;
National Drug Code name: Panglobulin[®] NF 12 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0418-12;
National Drug Code name: Panglobulin[®] NF 12 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0471-75;
National Drug Code name: Polygam[®] S/D 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 52769-0471-80;
National Drug Code name: Polygam[®] S/D 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 54129-0233-50;
National Drug Code name: Iveegam[®] 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9941, Injection, Immune Globulin, Intravenous,
Lyophilized, 1 g;
National Drug Code: 64193-0250-50;
National Drug Code name: Iveegam[®] EN 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0646-24;
National Drug Code name: Gamimune[®] N 5% 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0646-25;
National Drug Code name: Gamimune[®] N 5% 12.5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0646-71;
National Drug Code name: Gamimune[®] N 5% 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0648-12;
National Drug Code name: Gamimune[®] N 10% 1 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0648-15;
National Drug Code name: Gamimune[®] N 10% 2.5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0648-20;
National Drug Code name: Gamimune[®] N 10% 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0648-24;
National Drug Code name: Gamimune[®] N 10% 20 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 00026-0648-71;
National Drug Code name: Gamimune[®] N 10% 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 49669-1613-01;
National Drug Code name: Venoglobulin[®] -S 5% 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 49669-1614-01;
National Drug Code name: Venoglobulin[®] -S 5% 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 49669-1622-01;
National Drug Code name: Venoglobulin[®] -S 10% 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 49669-1623-01;
National Drug Code name: Venoglobulin[®] -S 10% 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 49669-1624-01;
National Drug Code name: Venoglobulin[®] -S 10% 20 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 61953-0003-03;
National Drug Code name: Flebogamma[®] 5% 5 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 61953-0003-04;
National Drug Code name: Flebogamma[®] 5% 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 68516-1623-01;
National Drug Code name: Venoglobulin[®] -S 10% 10 g.
Rank in Medicare spending on drug SCODs: 4[A];
HCPCS and description: Q9943, Injection, Immune Globulin, Intravenous,
Non-Lyophilized, 1 g;
National Drug Code: 68516-1624-01;
National Drug Code name: Venoglobulin[®] -S 10% 20 g.
Rank in Medicare spending on drug SCODs: 5;
HCPCS and description: J1745, Injection, Infliximab, 10 mg;
National Drug Code: 57894-0030-01;
National Drug Code name: Remicade[®] 100 mg.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513- 0010-01;
National Drug Code name: Aranesp[®] 25 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0010-04;
National Drug Code name: Aranesp[®] 25 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0011-04;
National Drug Code name: Aranesp[®] 40 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0012-04;
National Drug Code name: Aranesp[®] 60 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0013-01;
National Drug Code name: Aranesp[®] 100 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0013-04;
National Drug Code name: Aranesp[®] 100 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0014-01;
National Drug Code name: Aranesp[®] 200 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0014-04;
National Drug Code name: Aranesp[®] 200 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0015-01;
National Drug Code name: Aranesp[®] 300 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0037-01;
National Drug Code name: Aranesp[®] 40 mcg/0.4 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0037-04;
National Drug Code name: Aranesp[®] 40 mcg/0.4 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0039-01;
National Drug Code name: Aranesp[®] 60 mcg/0.3 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0039-04;
National Drug Code name: Aranesp[®] 60 mcg/0.3 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0041-01;
National Drug Code name: Aranesp[®] 100 mcg/0.5 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0041-04;
National Drug Code name: Aranesp[®] 100 mcg/0.5 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0043-04;
National Drug Code name: Aranesp[®] 150 mcg/0.3 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0044-01;
National Drug Code name: Aranesp[®] 200 mcg/0.4 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0046-01;
National Drug Code name: Aranesp[®] 300 mcg/0.6 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0048-01;
National Drug Code name: Aranesp[®] 500 mcg/mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0054-01;
National Drug Code name: Aranesp[®] 150 mcg/0.75 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0054-04;
National Drug Code name: Aranesp[®] 150 mcg/0.75 mL.
Rank in Medicare spending on drug SCODs: 6;
HCPCS and description: Q0137, Injection, Darbepoetin alfa, 1 mcg (non-
ESRD use);
National Drug Code: 55513-0058-04;
National Drug Code name: Aranesp[®] 25 mcg/0.42 mL.
Rank in Medicare spending on drug SCODs: 7;
HCPCS and description: J9170, Docetaxel, 20 mg;
National Drug Code: 00075-8001-20;
National Drug Code name: Taxotere[®] 20 mg/0.5 mL.
Rank in Medicare spending on drug SCODs: 7;
HCPCS and description: J9170, Docetaxel, 20 mg;
National Drug Code: 00075-8001-80;
National Drug Code name: Taxotere[®] 80 mg/2 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3210-30;
National Drug Code name: Paraplatin[®] 50 mg/5 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3210-76;
National Drug Code name: Paraplatin[®] 50 mg/5 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3211-30;
National Drug Code name: Paraplatin[®] 150 mg/15 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3211-76;
National Drug Code name: Paraplatin[®] 150 mg/15 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3212-30;
National Drug Code name: Paraplatin[®] 450 mg/45 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3212-76;
National Drug Code name: Paraplatin[®] 450 mg/45 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3213-29;
National Drug Code name: Paraplatin[®] 50 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3213-30;
National Drug Code name: Paraplatin[®] 50 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3214-29;
National Drug Code name: Paraplatin[®] 150 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3214-30;
National Drug Code name: Paraplatin[®] 150 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3215-29;
National Drug Code name: Paraplatin[®] 450 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3215-30;
National Drug Code name: Paraplatin[®] 450 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00015-3216-30;
National Drug Code name: Paraplatin[®] 600 mg/60 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00703-3244-11;
National Drug Code name: Carboplatin 50 mg/5 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00703-3246-11;
National Drug Code name: Carboplatin 150 mg/15 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00703-3248-11;
National Drug Code name: Carboplatin 450 mg/45 mL.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00703-3266-01;
National Drug Code name: Carboplatin 150 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 00703-3268-01;
National Drug Code name: Carboplatin 450 mg.
Rank in Medicare spending on drug SCODs: 8;
HCPCS and description: J9045, Carboplatin, 50 mg;
National Drug Code: 63323-0167-20;
National Drug Code name: Carboplatin 150 mg.
Rank in Medicare spending on drug SCODs: 9;
HCPCS and description: C9205, Injection, Oxaliplatin, per 5 mg;
National Drug Code: 00024-0596-02;
National Drug Code name: Eloxatin[TM] 50 mg.
Rank in Medicare spending on drug SCODs: 9;
HCPCS and description: C9205, Injection, Oxaliplatin, per 5 mg;
National Drug Code: 00024-0597-04;
National Drug Code name: Eloxatin[TM] 100 mg.
Rank in Medicare spending on drug SCODs: 10;
HCPCS and description: J3487, Injection, Zoledronic Acid, 1 mg;
National Drug Code: 00078-0350-84;
National Drug Code name: Zometa[®] 4 mg.
Rank in Medicare spending on drug SCODs: 10;
HCPCS and description: J3487, Injection, Zoledronic Acid, 1 mg;
National Drug Code: 00078-0387-25;
National Drug Code name: Zometa[®] 4 mg/5 mL.
Rank in Medicare spending on drug SCODs: 11;
HCPCS and description: J9201, Gemcitabine Hcl, 200 mg;
National Drug Code: 00002-7501-01;
National Drug Code name: Gemzar[®] 200 mg.
Rank in Medicare spending on drug SCODs: 11;
HCPCS and description: J9201, Gemcitabine Hcl, 200 mg;
National Drug Code: 00002-7502-01;
National Drug Code name: Gemzar[®] 1 g.
Rank in Medicare spending on drug SCODs: 12;
HCPCS and description: J9206, Irinotecan, 20 mg;
National Drug Code: 00009-7529-01;
National Drug Code name: Camptosar[®] 20 mg/mL.
Rank in Medicare spending on drug SCODs: 12;
HCPCS and description: J9206, Irinotecan, 20 mg;
National Drug Code: 00009-7529-02;
National Drug Code name: Camptosar[®] 20 mg/mL.
Rank in Medicare spending on drug SCODs: 13;
HCPCS and description: J2324, Injection, Nesiritide, 0.25 mg;
National Drug Code: 65847-0205-25;
National Drug Code name: Natrecor[®] 1.5 mg.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00074-4335-01;
National Drug Code name: Paclitaxel 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00074-4335-02;
National Drug Code name: Paclitaxel 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00074-4335-04;
National Drug Code name: Paclitaxel 300 mg/50 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3753-77;
National Drug Code name: Onxol[®] 6 mg/mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3753-96;
National Drug Code name: Onxol[®] 6 mg/mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3754-73;
National Drug Code name: Onxol[®] 6 mg/mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3754-94;
National Drug Code name: Onxol[®] 6 mg/mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3755-31;
National Drug Code name: Onxol[®] 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3756-75;
National Drug Code name: Onxol[®] 6 mg/mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 00172-3756-95;
National Drug Code name: Onxol[®] 6 mg/mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 51079-0961-01;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 51079-0962-01;
National Drug Code name: Paclitaxel 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 51079-0963-01;
National Drug Code name: Paclitaxel 300 mg/50 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 55390-0114-05;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 55390-0114-20;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 55390-0114-50;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 55390-0314-05;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 55390-0314-20;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 55390-0314-50;
National Drug Code name: Paclitaxel 30 mg/5 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 61703-0342-09;
National Drug Code name: Paclitaxel 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 61703-0342-22;
National Drug Code name: Paclitaxel 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 14;
HCPCS and description: J9265, Paclitaxel, 30 mg;
National Drug Code: 61703-0342-50;
National Drug Code name: Paclitaxel 100 mg/16.7 mL.
Rank in Medicare spending on drug SCODs: 15;
HCPCS and description: J9355, Trastuzumab, 10 mg;
National Drug Code: 50242-0134-60;
National Drug Code name: Herceptin[®] 440 mg.
Rank in Medicare spending on drug SCODs: 15;
HCPCS and description: J9355, Trastuzumab, 10 mg;
National Drug Code: 50242-0134-68;
National Drug Code name: Herceptin[®] 440 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00024- 0222-05;
National Drug Code name: Eligard[®] 22.5 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00024-0597-07;
National Drug Code name: Eligard[®] 7.5 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00024-0597-22;
National Drug Code name: Eligard[®] 22.5 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00024-0610-30;
National Drug Code name: Eligard[®] 30 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00024-0793-75;
National Drug Code name: Eligard[®] 7.5 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00300-3346-01;
National Drug Code name: Lupron Depot[®] 22.5 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00300-3642-01;
National Drug Code name: Lupron Depot[®] 7.5 mg.
Rank in Medicare spending on drug SCODs: 16;
HCPCS and description: J9217, Leuprolide Acetate (for depot
suspension), 7.5 mg;
National Drug Code: 00300-3683-01;
National Drug Code name: Lupron Depot[®] 30 mg.
Rank in Medicare spending on drug SCODs: 17;
HCPCS and description: J0256, Injection, Alpha 1 - Proteinase
Inhibitor - Human, 10 mg;
National Drug Code: 00026-0601-30;
National Drug Code name: Prolastin[®] approx 500 mg.
Rank in Medicare spending on drug SCODs: 17;
HCPCS and description: J0256, Injection, Alpha 1 - Proteinase
Inhibitor - Human, 10 mg;
National Drug Code: 00026-0601-35;
National Drug Code name: Prolastin[®] approx 1000 mg.
Rank in Medicare spending on drug SCODs: 17;
HCPCS and description: J0256, Injection, Alpha 1 - Proteinase
Inhibitor - Human, 10 mg;
National Drug Code: 00053-7201-02;
National Drug Code name: Zemaira[TM] approx 1000 mg.
Rank in Medicare spending on drug SCODs: 17;
HCPCS and description: J0256, Injection, Alpha 1 - Proteinase
Inhibitor - Human, 10 mg;
National Drug Code: 49669-5800-02;
National Drug Code name: Aralast[®] approx 1000 mg.
Rank in Medicare spending on drug SCODs: 18;
HCPCS and description: J9035,[B] Injection, Bevacizumab, 10 mg;
National Drug Code: 50242-0060-01;
National Drug Code name: Avastin[TM] 100 mg/4 mL.
Rank in Medicare spending on drug SCODs: 18;
HCPCS and description: J9035,[B] Injection, Bevacizumab, 10 mg;
National Drug Code: 50242-0060-02;
National Drug Code name: Avastin[TM] 400 mg/16 mL.
Rank in Medicare spending on drug SCODs: 19;
HCPCS and description: J1441, Injection, Filgrastim (G-CSF), 480 mcg;
National Drug Code: 55513-0209-01;
National Drug Code name: Neupogen[®] 480 mcg/0.8 mL.
Rank in Medicare spending on drug SCODs: 19;
HCPCS and description: J1441, Injection, Filgrastim (G-CSF), 480 mcg;
National Drug Code: 55513-0209-10;
National Drug Code name: Neupogen[®] 480 mcg/0.8 mL.
Rank in Medicare spending on drug SCODs: 19;
HCPCS and description: J1441, Injection, Filgrastim (G-CSF), 480 mcg;
National Drug Code: 55513-0546-01;
National Drug Code name: Neupogen[®] 480 mcg/1.6 mL.
Rank in Medicare spending on drug SCODs: 19;
HCPCS and description: J1441, Injection, Filgrastim (G-CSF), 480 mcg;
National Drug Code: 55513-0546-10;
National Drug Code name: Neupogen[®] 480 mcg/1.6 mL.
Rank in Medicare spending on drug SCODs: 20;
HCPCS and description: J1950, Injection, Leuprolide Acetate (for depot
suspension), per 3.75 mg;
National Drug Code: 00300-3641-01;
National Drug Code name: Lupron Depot[®] 3.75 mg.
Rank in Medicare spending on drug SCODs: 20;
HCPCS and description: J1950, Injection, Leuprolide Acetate (for depot
suspension), per 3.75 mg;
National Drug Code: 00300-3663-01;
National Drug Code name: Lupron Depot[®] 11.25 mg.
Rank in Medicare spending on drug SCODs: 21;
HCPCS and description: J9001, Doxorubicin Hydrochloride, all lipid
formulations, 10 mg;
National Drug Code: 17314-9600-01;
National Drug Code name: Doxil[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 21;
HCPCS and description: J9001, Doxorubicin Hydrochloride, all lipid
formulations, 10 mg;
National Drug Code: 17314-9600-02;
National Drug Code name: Doxil[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 22;
HCPCS and description: J2353, Injection, Octreotide, depot form for
intramuscular injection, 1 mg;
National Drug Code: 00078-0340-84;
National Drug Code name: Sandostatin LAR[®] Depot 10 mg.
Rank in Medicare spending on drug SCODs: 22;
HCPCS and description: J2353, Injection, Octreotide, depot form for
intramuscular injection, 1 mg;
National Drug Code: 00078-0341-84;
National Drug Code name: Sandostatin LAR[®] Depot 20 mg.
Rank in Medicare spending on drug SCODs: 22;
HCPCS and description: J2353, Injection, Octreotide, depot form for
intramuscular injection, 1 mg;
National Drug Code: 00078-0342-84;
National Drug Code name: Sandostatin LAR[®] Depot 30 mg.
Rank in Medicare spending on drug SCODs: 23;
HCPCS and description: J9055,[B] Injection, Cetuximab, 10 mg;
National Drug Code: 66733-0948-23;
National Drug Code name: Erbitux[TM] 100 mg/50 mL.
Rank in Medicare spending on drug SCODs: 24;
HCPCS and description: J9041,[B] Injection, Bortezomib, 0.1 mg;
National Drug Code: 63020-0049-01;
National Drug Code name: Velcade[®] 3.5 mg.
Rank in Medicare spending on drug SCODs: 25;
HCPCS and description: J9350, Topotecan, 4 mg;
National Drug Code: 00007-4201-01;
National Drug Code name: Hycamtin[®] 4 mg.
Rank in Medicare spending on drug SCODs: 25;
HCPCS and description: J9350, Topotecan, 4 mg;
National Drug Code: 00007-4201-05;
National Drug Code name: Hycamtin[®] 4 mg.
Rank in Medicare spending on drug SCODs: 26;
HCPCS and description: J1440, Injection, Filgrastim (G-CSF), 300 mcg;
National Drug Code: 55513-0530-01;
National Drug Code name: Neupogen[®] 300 mcg/mL.
Rank in Medicare spending on drug SCODs: 26;
HCPCS and description: J1440, Injection, Filgrastim (G-CSF), 300 mcg;
National Drug Code: 55513-0530-10;
National Drug Code name: Neupogen[®] 300 mcg/mL.
Rank in Medicare spending on drug SCODs: 26;
HCPCS and description: J1440, Injection, Filgrastim (G-CSF), 300 mcg;
National Drug Code: 55513-0924-10;
National Drug Code name: Neupogen[®] 300 mcg/0.5 mL.
Rank in Medicare spending on drug SCODs: 27;
HCPCS and description: J1785, Injection, Imiglucerase, per unit;
National Drug Code: 58468-1983-01;
National Drug Code name: Cerezyme[®] 200 unit.
Rank in Medicare spending on drug SCODs: 27;
HCPCS and description: J1785, Injection, Imiglucerase, per unit;
National Drug Code: 58468-4663-01;
National Drug Code name: Cerezyme[®] 400 unit.
Rank in Medicare spending on drug SCODs: 28;
HCPCS and description: J3396, Injection, Verteporfin, 0.1 mg;
National Drug Code: 58768-0150-15;
National Drug Code name: Visudyne[®] 15 mg.
Rank in Medicare spending on drug SCODs: 29;
HCPCS and description: J9202, Goserelin Acetate Implant, per 3.6 mg;
National Drug Code: 00310-0950-36;
National Drug Code name: Zoladex[®] 3.6 mg.
Rank in Medicare spending on drug SCODs: 29;
HCPCS and description: J9202, Goserelin Acetate Implant, per 3.6 mg;
National Drug Code: 00310-0951-30;
National Drug Code name: Zoladex[®] 10.8 mg.
Rank in Medicare spending on drug SCODs: 29;
HCPCS and description: J9202, Goserelin Acetate Implant, per 3.6 mg;
National Drug Code: 00310-0960-36;
National Drug Code name: Zoladex[®] 3.6 mg.
Rank in Medicare spending on drug SCODs: 29;
HCPCS and description: J9202, Goserelin Acetate Implant, per 3.6 mg;
National Drug Code: 00310-0961-30;
National Drug Code name: Zoladex[®] 10.8 mg.
Rank in Medicare spending on drug SCODs: 30;
HCPCS and description: J1626, Injection, Granisetron Hydrochloride, 100
mcg;
National Drug Code: 00004-0239- 09;
National Drug Code name: Kytril[®] 1 mg/mL.
Rank in Medicare spending on drug SCODs: 30;
HCPCS and description: J1626, Injection, Granisetron Hydrochloride, 100
mcg;
National Drug Code: 00004-0240-09;
National Drug Code name: Kytril[®] 1 mg/mL.
Rank in Medicare spending on drug SCODs: 30;
HCPCS and description: J1626, Injection, Granisetron Hydrochloride, 100
mcg;
National Drug Code: 00029-4149-01;
National Drug Code name: Kytril[®] 1 mg/mL.
Rank in Medicare spending on drug SCODs: 31;
HCPCS and description: J0585, Botulinim Toxin Type A, per unit;
National Drug Code: 00023-1145-01;
National Drug Code name: Botox[®] 100 unit.
Rank in Medicare spending on drug SCODs: 32;
HCPCS and description: J0207, Injection, Amifostine, 500 mg;
National Drug Code: 17314-7253-03;
National Drug Code name: Ethyol[®] 500 mg.
Rank in Medicare spending on drug SCODs: 32;
HCPCS and description: J0207, Injection, Amifostine, 500 mg;
National Drug Code: 58178-0017-03;
National Drug Code name: Ethyol[®] 500 mg.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 00703-4075-19;
National Drug Code name: Pamidronate Disodium 30 mg/10 mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 00703-4085-11;
National Drug Code name: Pamidronate Disodium 90 mg/10 mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 00703-4085-91;
National Drug Code name: Pamidronate Disodium 90 mg/10 mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 55390-0127-01;
National Drug Code name: Pamidronate Disodium 30 mg.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 55390-0129-01;
National Drug Code name: Pamidronate Disodium 90 mg.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 55390-0157-01;
National Drug Code name: Pamidronate Disodium 30 mg.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 55390-0159-01;
National Drug Code name: Pamidronate Disodium 90 mg.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 55390-0204-01;
National Drug Code name: Pamidronate Disodium 30 mg/10 mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 55390-0604-01;
National Drug Code name: Pamidronate Disodium 30 mg/10 mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 61703-0325-18;
National Drug Code name: Pamidronate Disodium 6 mg/mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 63323-0734-10;
National Drug Code name: Pamidronate Disodium 30 mg/10 mL.
Rank in Medicare spending on drug SCODs: 33;
HCPCS and description: J2430, Injection, Pamidronate Disodium, per 30
mg;
National Drug Code: 63323-0735-10;
National Drug Code name: Pamidronate Disodium 90 mg/10 mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 00703-4182-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 00703-4182-91;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 00703-4183-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 00703-4183-91;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 10019-0970-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 10019-0970-02;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 55390-0069-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 55390-0070-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 59911-5958-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 34;
HCPCS and description: J9390, Vinorelbine Tartrate, per 10 mg;
National Drug Code: 59911-5959-01;
National Drug Code name: Vinorelbine Tartrate 10 mg/mL.
Rank in Medicare spending on drug SCODs: 35;
HCPCS and description: J2993, Injection, Reteplase, 18.1 mg;
National Drug Code: 57894-0040-01;
National Drug Code name: Retavase[®] 2x18.1 mg.
Rank in Medicare spending on drug SCODs: 35;
HCPCS and description: J2993, Injection, Reteplase, 18.1 mg;
National Drug Code: 57894-0040-02;
National Drug Code name: Retavase[®] 18.1 mg.
Rank in Medicare spending on drug SCODs: 36;
HCPCS and description: J9293, Injection, Mitoxantrone Hydrochloride,
per 5 mg;
National Drug Code: 44087-1520- 01;
National Drug Code name: Novantrone[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 36;
HCPCS and description: J9293, Injection, Mitoxantrone Hydrochloride,
per 5 mg;
National Drug Code: 44087-1525-01;
National Drug Code name: Novantrone[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 36;
HCPCS and description: J9293, Injection, Mitoxantrone Hydrochloride,
per 5 mg;
National Drug Code: 44087-1530-01;
National Drug Code name: Novantrone[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 36;
HCPCS and description: J9293, Injection, Mitoxantrone Hydrochloride,
per 5 mg;
National Drug Code: 58406-0640-03;
National Drug Code name: Novantrone[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 36;
HCPCS and description: J9293, Injection, Mitoxantrone Hydrochloride,
per 5 mg;
National Drug Code: 58406-0640-05;
National Drug Code name: Novantrone[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 36;
HCPCS and description: J9293, Injection, Mitoxantrone Hydrochloride,
per 5 mg;
National Drug Code: 58406-0640-07;
National Drug Code name: Novantrone[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 37;
HCPCS and description: J9185, Fludarabine Phosphate, 50 mg;
National Drug Code: 00703-5854-01;
National Drug Code name: Fludarabine Phosphate 50 mg.
Rank in Medicare spending on drug SCODs: 37;
HCPCS and description: J9185, Fludarabine Phosphate, 50 mg;
National Drug Code: 50419-0511-06;
National Drug Code name: Fludara[®] 50 mg.
Rank in Medicare spending on drug SCODs: 38;
HCPCS and description: C1305, Apligraf[®] , per 44 square centimeters;
National Drug Code: 09978-0001-99;
National Drug Code name: Apligraf[®].
Rank in Medicare spending on drug SCODs: 39;
HCPCS and description: J9395, Injection, Fulvestrant, 25 mg;
National Drug Code: 00310-0720-25;
National Drug Code name: Faslodex[®] 125 mg/2.5 mL.
Rank in Medicare spending on drug SCODs: 39;
HCPCS and description: J9395, Injection, Fulvestrant, 25 mg;
National Drug Code: 00310-0720-50;
National Drug Code name: Faslodex[®] 250 mg/5 mL.
Rank in Medicare spending on drug SCODs: 40;
HCPCS and description: J3100, Injection, Tenecteplase, 50 mg;
National Drug Code: 50242-0038-61;
National Drug Code name: TNKase[TM] 50 mg.
Rank in Medicare spending on drug SCODs: 41;
HCPCS and description: J9305,[B] Injection, Pemetrexed, 10 mg;
National Drug Code: 00002-7623-01;
National Drug Code name: Alimta[®] 500 mg.
Rank in Medicare spending on drug SCODs: 42;
HCPCS and description: J9160, Denileukin Diftitox, 300 mcg;
National Drug Code: 64365-0503-01;
National Drug Code name: Ontak[®] 150 mcg/mL.
Rank in Medicare spending on drug SCODs: 43;
HCPCS and description: J0180,[B] Injection, Agalsidase Beta, 1 mg;
National Drug Code: 58468-0040-01;
National Drug Code name: Fabrazyme[®] 35 mg.
Rank in Medicare spending on drug SCODs: 43;
HCPCS and description: J0180,[B] Injection, Agalsidase Beta, 1 mg;
National Drug Code: 58468-0041-01;
National Drug Code name: Fabrazyme[®] 5 mg.
Rank in Medicare spending on drug SCODs: 44;
HCPCS and description: Q0166, Granisetron Hydrochloride, 1 mg, oral[C];
National Drug Code: 00004-0237-09;
National Drug Code name: Kytril[®] 2 mg/10 mL.
Rank in Medicare spending on drug SCODs: 44;
HCPCS and description: Q0166, Granisetron Hydrochloride, 1 mg, oral[C];
National Drug Code: 00004-0241-26;
National Drug Code name: Kytril[®] 1 mg.
Rank in Medicare spending on drug SCODs: 44;
HCPCS and description: Q0166, Granisetron Hydrochloride, 1 mg, oral[C];
National Drug Code: 00004-0241-33;
National Drug Code name: Kytril[®] 1 mg.
Rank in Medicare spending on drug SCODs: 44;
HCPCS and description: Q0166, Granisetron Hydrochloride, 1 mg, oral[C];
National Drug Code: 00029-4151-05;
National Drug Code name: Kytril[®] 1 mg.
Rank in Medicare spending on drug SCODs: 45;
HCPCS and description: J2469,[B] Injection, Palonosetron Hcl, 25 mcg;
National Drug Code: 58063-0797-25;
National Drug Code name: Aloxi[®] 0.25 mg/5 mL.
Rank in Medicare spending on drug SCODs: 46;
HCPCS and description: J9010, Alemtuzumab, 10 mg;
National Drug Code: 50419-0355-10;
National Drug Code name: CamPath[®] 10 mg/mL.
Rank in Medicare spending on drug SCODs: 46;
HCPCS and description: J9010, Alemtuzumab, 10 mg;
National Drug Code: 50419-0355-12;
National Drug Code name: CamPath[®] 10 mg/mL.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00053-7486-05;
National Drug Code name: Gammar[®] -P IV 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00053-7486-06;
National Drug Code name: Gammar[®] -P IV 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00053-7486-10;
National Drug Code name: Gammar[®] -P IV 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00078-0124-96;
National Drug Code name: Sandoglobulin[®] 6 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00944-2620-01;
National Drug Code name: Gammagard[®] S/D 0.5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00944-2620-02;
National Drug Code name: Gammagard[®] S/D 2.5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00944-2620-03;
National Drug Code name: Gammagard[®] S/D 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 00944-2620-04;
National Drug Code name: Gammagard[®] S/D 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 44206-0416-03;
National Drug Code name: Carimune[®] NF 3 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 44206-0417-06;
National Drug Code name: Carimune[®] NF 6 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 44206-0418-12;
National Drug Code name: Carimune[®] NF 12 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 44206-0505-51;
National Drug Code name: Carimune[®] 1 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 44206-0507-56;
National Drug Code name: Carimune[®] 6 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 44206-0508-62;
National Drug Code name: Carimune[®] 12 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0268-66;
National Drug Code name: Panglobulin[®] 6 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0269-72;
National Drug Code name: Panglobulin[®] 12 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0417-06;
National Drug Code name: Panglobulin[®] NF 6 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0417-12;
National Drug Code name: Panglobulin[®] NF 12 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0418-12;
National Drug Code name: Panglobulin[®] NF 12 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0471-75;
National Drug Code name: Polygam[®] S/D 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 52769-0471-80;
National Drug Code name: Polygam[®] S/D 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 54129-0233-50;
National Drug Code name: Iveegam[®] 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9942, Injection, Immune Globulin, Intravenous,
Lyophilized, 10 mg;
National Drug Code: 64193-0250-50;
National Drug Code name: Iveegam[®] EN 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0646-24;
National Drug Code name: Gamimune[®] N 5% 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0646-25;
National Drug Code name: Gamimune[®] N 5% 12.5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0646-71;
National Drug Code name: Gamimune[®] N 5% 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0648-12;
National Drug Code name: Gamimune[®] N 10% 1 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0648-15;
National Drug Code name: Gamimune[®] N 10% 2.5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0648-20;
National Drug Code name: Gamimune[®] N 10% 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0648-24;
National Drug Code name: Gamimune[®] N 10% 20 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 00026-0648-71;
National Drug Code name: Gamimune[®] N 10% 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 49669-1613-01;
National Drug Code name: Venoglobulin[®] -S 5% 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 49669-1614-01;
National Drug Code name: Venoglobulin[®] -S 5% 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 49669-1622-01;
National Drug Code name: Venoglobulin[®] -S 10% 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 49669-1623-01;
National Drug Code name: Venoglobulin[®] -S 10% 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 49669-1624-01;
National Drug Code name: Venoglobulin[®] -S 10% 20 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 61953-0003-03;
National Drug Code name: Flebogamma[®] 5% 5 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 61953-0003-04;
National Drug Code name: Flebogamma[®] 5% 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 68516-1623-01;
National Drug Code name: Venoglobulin[®] -S 10% 10 g.
Rank in Medicare spending on drug SCODs: 47[D];
HCPCS and description: Q9944, Injection, Immune Globulin, Intravenous,
Non- Lyophilized, 10 mg;
National Drug Code: 68516-1624-01;
National Drug Code name: Venoglobulin[®] -S 10% 20 g.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00026- 0665-20;
National Drug Code name: Koate[®] -DVI 250 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00026-0665-30;
National Drug Code name: Koate[®] -DVI 500 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00026-0665-50;
National Drug Code name: Koate[®] -DVI 1000 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00053-7656-01;
National Drug Code name: Monoclate-P[®] 250 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00053-7656-02;
National Drug Code name: Monoclate-P[®] 500 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00053-7656-04;
National Drug Code name: Monoclate-P[®] 1000 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 00944-2935-01;
National Drug Code name: Hemofil[®] M 200-1000 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 49669-4600-01;
National Drug Code name: Alphanate[®] 250-500 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 49669-4600-02;
National Drug Code name: Alphanate[®] 1000-1500 unit.
Rank in Medicare spending on drug SCODs: 48;
HCPCS and description: J7190, Factor VIII (Antihemophilic Factor,
Human) per I.U;
National Drug Code: 52769-0460-01;
National Drug Code name: Monarc-M[TM] 250-1100 unit.
Rank in Medicare spending on drug SCODs: 49;
HCPCS and description: J0130, Injection, Abciximab, 10 mg;
National Drug Code: 00002-7140-01;
National Drug Code name: Reopro[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 50;
HCPCS and description: J0850, Injection, Cytomegalovirus Immune
Globulin, Intravenous (Human), per vial;
National Drug Code: 60574-3101-01;
National Drug Code name: CytoGam[®].
Rank in Medicare spending on drug SCODs: 51;
HCPCS and description: J1327, Injection, Eptifibatide, 5 mg;
National Drug Code: 00085-1136-01;
National Drug Code name: Integrilin[®] 0.75 mg/mL.
Rank in Medicare spending on drug SCODs: 51;
HCPCS and description: J1327, Injection, Eptifibatide, 5 mg;
National Drug Code: 00085-1177-01;
National Drug Code name: Integrilin[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 51;
HCPCS and description: J1327, Injection, Eptifibatide, 5 mg;
National Drug Code: 00085-1177-02;
National Drug Code name: Integrilin[®] 2 mg/mL.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085- 0120-02;
National Drug Code name: Intron[®] A 5 million units.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-0285-02;
National Drug Code name: Intron[®] A 25 million units.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-0539-01;
National Drug Code name: Intron[®] A 50 million units.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-0571-02;
National Drug Code name: Intron[®] A 10 million units.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-0647-05;
National Drug Code name: Intron[®] A 3 million units.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1110-01;
National Drug Code name: Intron[®] A 18 million units.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1133-01;
National Drug Code name: Intron[®] A 10 million units/mL.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1168-01;
National Drug Code name: Intron[®] A 6 million units/mL.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1179-02;
National Drug Code name: Intron[®] A 10 million units/mL.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1235-01;
National Drug Code name: Intron[®] A 5 million units/0.2 mL.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1242-01;
National Drug Code name: Intron[®] A 3 million units/0.2 mL.
Rank in Medicare spending on drug SCODs: 52;
HCPCS and description: J9214, Interferon, Alfa-2B, Recombinant, 1
million units;
National Drug Code: 00085-1254-01;
National Drug Code name: Intron[®] A 10 million units/0.2 mL.
Rank in Medicare spending on drug SCODs: 53;
HCPCS and description: C9201, Dermagraft[®] , per 37.5 square
centimeters;
National Drug Code: 38172-0202-00;
National Drug Code name: Dermagraft[®] 5 cm x 7.5 cm.
Sources: GAO survey and CMS.
Note: ESRD = end-stage renal disease, mL = milliliter, mg = milligram,
g = gram, mcg = microgram, I.U. = international unit, cm = centimeter.
[A] On April 1, 2005, CMS replaced J1563, Injection, Immune Globulin,
Intravenous, 1g, with two new codes: Q9941 and Q9943. J1563 was ranked
fourth in total Medicare spending on SCODs from January 1, 2004, to
September 30, 2004.
[B] On January 1, 2005, CMS replaced C9214, C9215, C9207, C9213, C9208,
and C9210 with J9035, J9055, J9041, J9305, J0180, and J2469,
respectively. The ranks for the new codes correspond to the ranks in
total Medicare spending on SCODs from January 1, 2004, to September 30,
2004, for the former codes.
[C] The complete description for HCPCS Q0166 is "Granisetron
Hydrochloride, 1 mg, Oral, FDA Approved Prescription Anti-Emetic, for
Use as a Complete Therapeutic Substitute for an IV Anti-Emetic at the
Time of Chemotherapy Treatment, Not to Exceed a 24 Hour Dosage Regimen."
[D] On April 1, 2005, CMS replaced J1564, Injection, Immune Globulin,
Intravenous, 10 mg, with two new codes: Q9942 and Q9944. J1564 was
ranked 47th in total Medicare spending on SCODs from January 1, 2004,
to September 30, 2004.
[End of table]
[End of section]
Enclosure III: Comments from the Department of Health and Human
Services:
DEPARTMENT OF HEALTH & HUMAN SERVICES:
Office of Inspector General:
Washington, D.C. 20201:
JUN 16 2005:
Mr. A. Bruce Steinwald:
Director:
Health Care-Economic and Payment Issues:
U.S. Government Accountability Office:
Washington, DC 20548:
Dear Mr. Steinwald:
Enclosed are the Department's comments on the U.S. Government
Accountability Office's (GAO's) draft correspondence entitled,
"Medicare: Drug Purchase Prices for CMS Consideration in Hospital
Outpatient Rate-Setting" (GAO-05- 581R). The comments represent the
tentative position of the Department and are subject to reevaluation
when the final version of this report is received.
The Department appreciates the opportunity to comment on this draft
report before its publication.
Sincerely,
Signed by:
Daniel R. Levinson:
Inspector General:
Enclosure:
The Office of Inspector General (OIG) is transmitting the Department's
response to this draft report in our capacity as the Department's
designated focal point and coordinator for U.S. Government
Accountability Office reports. OIG has not conducted an independent
assessment of these comments and therefore expresses no opinion on
them.
COMMENTS OF THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ON THE
U.S. GOVERNMENT ACCOUNTABILITY OFFICE'S REPORT ENTITLED, "MEDICARE:
DRUG PURCHASE PRICES FOR CMS CONSIDERATION IN HOSPITAL OUTPATIENT RATE-
SETTING" (GAO-05-581R):
The Department of Health and Human Services appreciates the opportunity
to review the Government Accountability Office's (GAO's) draft report.
Paying appropriately for drugs and related pharmacy overhead resources
under the outpatient prospective payment system is a priority for the
Centers for Medicare & Medicaid Services. We commend the efforts of GAO
and recognize the challenges of accurately surveying hospitals for drug
acquisition costs. The draft provided by GAO focused on hospital drug
purchase prices, which are one component of hospital drug acquisition
costs. As the report points out, drug acquisition costs are also
influenced by rebates from drug manufacturers and payments from group
purchasing organizations. We are concerned about some of the
limitations noted in the report about the purchase price survey, such
as the difficulties hospitals have in allocating rebates from
manufacturers and payments from group purchasing organizations to drug
acquisition costs. Also, we foresee concerns about the potential for
the purchase prices to have changed since the time period GAO surveyed
hospitals.
We will take the survey data into account as we develop the proposed
payment rates for 2006. We believe it is important as we develop the
payment rates for 2006, and future years, to have a methodology that
can be updated in an appropriate manner and reflects the rebates and
other price concessions that influence drug acquisition costs.
[End of section]
Enclosure IV: GAO Contact and Staff Acknowledgments:
GAO Contact:
Phyllis Thorburn, (202) 512-7012:
Acknowledgments:
Dae Park, Jonathan Ratner, Anna Theisen-Olson, Kaycee Misiewicz, Thomas
Walke, Martha Kelly, Suzanne Worth, Hannah Fein, Richard Lipinski,
Daniel Ries, Mike Thomas, Elizabeth T. Morrison, and Todd Anderson
contributed to this report.
(290352):
FOOTNOTES
[1] Pub. L. No. 105-33, § 4523, 111 Stat. 251, 445--450.
[2] In this report, we use the term "drugs" to refer to both drugs and
biologicals. Biologicals are products derived from living sources,
including humans, animals, and microorganisms.
[3] Radiopharmaceuticals are radioactive drugs used for diagnostic or
therapeutic purposes; for this report, radiopharmaceuticals are not
included in the term "drugs."
[4] Pub. L. No. 106-113, app. F, § 201(b), 113 Stat. 1501A-321, 1501A-
337--1501A-339.
[5] Pub. L. No. 108-173, § 621(a), 117 Stat. 2066, 2307--2310.
[6] Under OPPS, CMS groups services into APCs on the basis of their
clinical and cost similarities. All services that are grouped into the
same APC have the same base payment rate. The MMA required CMS to
establish a separate APC for a pharmaceutical product if the cost per
administration is $50 or more. MMA 117 Stat. 2310. Drugs that cost less
than $50 per administration are bundled with other services for payment
purposes. CMS has interpreted the cost per administration as the median
cost per day.
[7] MMA 117 Stat. 2308.
[8] MMA 117 Stat. 2308. In addition, the MMA required the Medicare
Payment Advisory Commission, known as MedPAC, to report on hospitals'
overhead costs and related expenses for SCODs for the Secretary's
consideration in setting 2006 payment rates. MMA 117 Stat. 2309.
Overhead costs are not part of acquisition costs. MedPAC's mandated
report is Chapter 6, "Payment for pharmacy handling costs in hospital
outpatient departments," in Issues in a Modernized Medicare Program
(Washington, D.C.: MedPAC, June 2005).
[9] After September 2004, when we began collecting data, CMS divided
two of these categories into two SCOD categories each, in effect adding
two categories and resulting in a total of 55 SCOD categories.
[10] For this report, the term SCOD includes both pharmaceutical
products that currently meet the definition of SCODs and those that do
not meet the definition now but that may be considered SCODs in the
future. The pharmaceutical products in this report that do not meet the
definition of SCODs include orphan drugs and drugs that are currently
on pass-through status.
[11] We have provided HHS with the average and median purchase prices
from our survey for all 53 SCOD categories--both those included in and
those excluded from this report--and their component drugs.
[12] Forty-eight of these hospitals were in our pilot survey, which
began on August 5, 2004.
[13] We contracted for data collection and much of the data processing
with a large survey firm with experience in conducting health care
surveys.
[14] Although SCODs by definition are used in hospital outpatient
departments, the data we received from hospitals may represent drugs
that were used for both inpatients and outpatients and for Medicare and
non-Medicare patients.
[15] For the specific drugs--identified by National Drug Code (NDC)--
within each HCPCS, see enc. II.
[16] Even if these hospitals did not have charges for SCODs in the
first 6 months of 2003, they might have made purchases for SCODs after
that time period. Therefore, it was important to include them in the
sample.
[17] We measured efficiency by the size of the reduction in sample
variation.
[18] We also used data from the 48 hospitals in the pilot survey, for a
total sample of 1,400 hospitals.
[19] Distributors are intermediaries that buy drugs from manufacturers
and sell them to hospitals.
[20] Our formulation of the hospital weight is an adaptation of the
usual formulation, in which Njh is divided by njh , the number of
hospitals in the hTH stratum that purchased the jTH SCOD. Unlike Rjh,
njh includes hospitals that did not respond to the survey and
consequently is not appropriate for our purpose.
[21] If independent samples are taken repeatedly from the same
population, and a confidence interval calculated for each sample, then
a certain percentage of the intervals will include the unknown average
for the population. The confidence level is often calculated so that
the percentage is 95 percent.
[22] W.G. Cochran, Sampling Techniques, 3RD ed., Wiley Series in
Probability and Mathematical Statistics, section 11.7 (New York, N.Y.:
John Wiley & Sons, 1977), 303.
[23] M.H. Hansen, W.N. Hurwitz, and W.G. Madow, Sample Survey Methods
and Theory, vol. I, Methods and Applications, Wiley Publications in
Statistics, sections 6.6 and 6.7 (New York, N.Y.: John Wiley & Sons,
Inc., 1953), 252-259.
[24] More precisely, this is a stratified cluster sample. "Cluster"
refers to the set of invoice records (for a given SCOD) reported by a
hospital. The size of a cluster varied widely among hospitals--from 1
invoice record for a given SCOD to over 800 records.
[25] D.A. Binder, "Use of Estimating Functions for Interval Estimation
from Complex Surveys," Proceedings of the Survey Research Methods
Section, American Statistical Association (1991).
[26] C.A. Francisco and W.A. Fuller, "Quantile Estimation with a
Complex Survey Design," Annals of Statistics, 19 (1991), 454-469.
[27] B.V. Shah, B.B. Barnwell, and G.S. Bieler, SUDAAN: User's Manual,
Release 7.5, vols. 1 and 2 (Research Triangle Park, N.C.: Research
Triangle Institute, 1997). SUDAAN® is a registered trademark of the
Research Triangle Institute.