Competitive Acquisition Program Christian G. Downs, JD, MHA Executive Director Association of Community Cancer Centers.

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Presentation transcript:

Competitive Acquisition Program Christian G. Downs, JD, MHA Executive Director Association of Community Cancer Centers

CAP No prescription drug coverage under the Medicare program Studies showed an overpayment for drugs MMA 2003 had several payment adjustments Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

CAP Available to physicians who administer drugs in their office under Part B Acquire drugs from vendors rather than purchase Program is voluntary Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

CAP A single national distribution area A single drug category for 181 drugs give “incident to” The physician/vendor enrollment process Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

CAP No change in coverage No change in out of pocket cost CMS thinks that long term costs could decrease somewhat Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

CAP Participation is voluntary Physician enrolls with vendor Vendor delivers drug Physician bills Medicare for professional and administrative services Vendor bills Medicare for drug Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

CAP CMS has set out standards for vendors Vendor must then apply to Medicare program Vendor will be selected based on bid price Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

CAP Not going into effect until July of 2006 Not popular with physicians as designed Not popular with vendors as designed Cost is issue attempting to be addressed Overview Background Program Structure Beneficiaries Physician Participation Vendor Selection Conclusions

REMEMBER "One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors." -Plato Christian G. Downs, JD, MHA Executive Director Association of Community Cancer Centers (301) ext 220