Lack of interest derails Medicare B drug program

By Jane Cys, AMNews correspondent. Nov. 10, 2008 in American Medical News The alternative purchasing system for drugs given in the office had only about 4,200 physicians and one drug vendor sign on in three years. Randolph Johnston, MD, a Cheyenne, Wyo., ophthalmologist, jumped at the chance to sign up for Medicare's competitive acquisition program in 2006. As a CAP participant, he no longer would have to buy the Part B drugs his practice used and then bill patients for them; instead, a drug vendor chosen by the government would take on those roles. It seemed to make financial sense. Because some of Dr. Johnston's patients had trouble paying for their office-administered drugs, the practice would get small monthly payments and carry over the balance -- often thousands of dollars. But administrative hassles, drug delivery problems and other troubles quickly dampened his enthusiasm. "After three months of the program, we wrote a letter and begged to be let out," said the vitreoretinal specialist, who will become the American Academy of Ophthalmology's president-elect in January 2009. Although CAP is voluntary, he was stuck with it for the rest of the year. Looking ahead CMS officials urged Medicare participants to use the CAP hiatus to suggest changes that could improve the program. The agency will hold an open door forum on the issue in December. The AMA remains unsure about the program's viability, given inadequate pay to doctors for many Part B drugs, wrote AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, in an August letter to CMS. Because payments to vendors under CAP are discounted, even below the average rates that doctors receive under Medicare, many vendors likely will decide CAP isn't worth it, he said.