- The Centers for Medicare & Medicaid Services (CMS) has issued its final update on the therapies facing expiration of pass-through status in 2018.
- Normal Medicare reimbursement is based on past claims, not possible for new products. Pass-through status, which allows payment for new products on a temporary basis, typically runs for two-to-three years to establish claims history. The pass-through price is first determined by the wholesale acquisition cost (WAC) plus 6%, then transitions to average selling price plus 6%.
- Affected products include:
- Omeros (NASDAQ:OMER): Omidria (phenylephrine and ketorolac injection)
- Eli Lilly (NYSE:LLY): Amyvid (florbetapir)
- Astellas (OTCPK:ALPMY)/Merck (NYSE:MRK): Zerbaxa (ceftolozane/tazobactam)
- Allergan (NYSE:AGN): Dalvance (dalbavancin)
- The Medicines Company (NASDAQ:MDCO): Orbactiv (oritavancin)
- Novartis (NYSE:NVS): Signifor (pasireotide)
- J&J (NYSE:JNJ): Sylvant (siltuximab)
- Alimera Sciences (NASDAQ:ALIM): Iluvien (fluocinolone acetonide intravitreal implant)
- Amgen (NASDAQ:AMGN): Blincyto (blinatumomab)
- Bristol-Myers Squibb (NYSE:BMY): Opdivo (nivolumab)
- Merck: Keytruda (pembrolizumab)
- Source: Bloomberg
- Now read: Eli Lilly Strives To Counteract Its Rivals
Original article