1 From University of Utah Pharmacotherapy Outcomes Research Center, Salt Lake City, Utah; Fairfax-Northern Virginia Hematology/Oncology, Fairfax, Virginia; and University of Utah Hospital Pharmacy Services, Salt Lake City, Utah.
Significant changes in Medicare reimbursement for outpatient oncology services were proposed as part of the Medicare Modernization Act of 2003. The purpose of this study was to identify the “true cost” associated with drug-related handling for the preparation and delivery of chemotherapy doses to estimate the impact of changing reimbursement schema by Medicare. Two academic medical outpatient infusion centers and 2 community cancer centers provided data used to estimate all costs (excluding drug cost) associated with the preparation of chemotherapy doses. The data included both fixed costs (drug storage, space, equipment, and information resources) and variable costs (insurance management, inventory, waste management, pharmacy staff payroll, supplies, and shipping). The average cost for the preparation of chemotherapy doses across all sites was $34.27 (range, $32.08–$41.23). A time-and-motion study was also performed to determine what tasks were conducted by pharmacy staff and how much time was spent in the preparation of the top 15 chemotherapeutic drugs and regimens used in the 4 sites. Data from the 4 centers was projected to show that if 3,990,495 million chemotherapy infusions were administered to a national Medicare population in 2003, when multiplied by the average cost of preparation for infusions determined by the current study ($34.27), the estimated total annual cost to Medicare for chemotherapy preparation by pharmacists is $136,754,263.65. The pharmacists spent most of their days (90% or more) performing tasks directly related to the preparation of these agents. These data provide scientific support for the consideration of appropriate reimbursement for chemotherapy services provided by pharmacists to Medicare beneficiaries.
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Correspondence: Diana I. Brixner, RPh, PhD, University of Utah Pharmacotherapy Outcomes Research Center, 421 Wakara Way, Suite 208, Salt Lake City, UT 84108. E-mail: firstname.lastname@example.org.
KeehanSPLazenbyHCZezzaMA. Age estimates in national health accounts. Health Care Financ RevDecember2004. Available at: http://www.cms.hhs.gov/healthcarefinancingreview/downloads/keehan.pdf. Accessed January 30 2006.
Davenport-EnnisN. National Patient Advocate Foundation. September 24 2004 (Letter). NPAF makes comments on CMS proposed rule CMS-1429-P. Available at: http://www.npaf.org/news.php?p=297. Accessed January 2006.
IglehartJK. The new medicare prescription drug benefit—a pure power play. N Engl J Med2004;350:826–833.
KleinkeJD. Re-naming and re-gaming: medicare's doomed attempt to reform reimbursement for injectable drugs. Health Affairs2004. Available at: http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.561v1. Accessed January 2006.
ChangSLongSRKutikovaL. Estimating the costs of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol2004;22:3524–3530.
Annual Report of the Boards of Trustees. Centers for Medicare & Medicaid Services Web site. Available atwww.kff.org/medicare/loader.cfmPurl-/commonspot/security/getfile.cfm&PageID=33319. Accessed January 30 2006.