Eyeworld

DECEMBER 2019 | EYEWORLD | 33 C Contact information McCann: nmccann@ASCRS.org Parekh: parag2020@gmail.com drugs from being included." ASCRS and OOSS also commented on the ASC outpatient pro- posed rule, advocating for taking drugs with postop indications administered at the time of surgery out of the facility payment. Earlier this year, the Rep. Steve Stivers (R-Ohio), Rep. David Price (D-North Caro- lina)—co-chairs of the Vision Caucus—Sen. Sherrod Brown (D-OH), Sen. Rand Paul, MD (R-KY), Sen. Doug Jones (D-AL), and Sen. John Boozman (R-AR) sent letters to CMS Ad- ministrator Seema Verma, encouraging CMS to include potential updates to the packaging poli- cy in its 2020 Hospital OPPS and ASC Payment System rulemaking. Specifically mentioning new ophthalmic drugs with postoperative indica- tions, the representatives and senators wrote that these drugs "benefit Medicare beneficiaries beyond a traditional surgical supply." "[I]t is critical that CMS develop a forward-looking mechanism to appropriately reimburse for new products that advance the standard of care for Medicare beneficiaries…," the senators and representatives continued. CMS released its final rule for the 2020 Hospital OPPS and ASC Payment System Policy Changes and Payment Rates in Novem- ber and did not make the requested change by ASCRS and OOSS to pay separately for these drugs under Medicare Part B. It did, however, describe how CMS made the decision to start paying for the drug Exparel (Pacira BioScienc- es) outside of the typical bundled payment for "surgical supplies" in an ASC setting, because once it went off pass-through status its use in the ASC setting went down significantly (in the hospital Exparel remains bundled in the facility fee). This, Ms. McCann said showed how CMS can take medications out of the facility-fee bun- dle due to the change in utilization of the drug in the ASC once it goes off pass-through. "Sometimes these kinds of policies take several years to change," Ms. McCann said. "If there isn't a viable payment pathway when a drug goes off pass-through, the companies are not going to continue to invest in these innova- tive drugs." not be negatively impacted if they use Omidria on patients with select comorbidities. "Do you really want to not have doctors use this drug because of the potential for pay- ment penalties? No. Because they're supposed to use [drugs on pass-through] based on merit," Ms. McCann said. At the time the measure was drafted, Omid- ria was the only drug for cataract surgery with pass-through status (its status was extended to Sept. 30, 2020). Since then, others have received pass-through status—namely Dexycu (Eye- Point Pharmaceuticals) and Dextenza (Ocular Therapeutix), which both have indications for reducing postop inflammation and pain. Dexy- cu and Dextenza are not currently included in the MIPS cataract episode cost measure, so physicians will not be penalized for using them at this time. The Ophthalmic Pharmaceutical Coali- tion is advocating to get Omidria off the cost measure, due to its pass-through status, and for CMS to not include any drugs on pass-through in this measure. CMS has not established a reg- ular schedule or given notice of if it will update the cataract cost measure. It will release 2020 specifications of all of the cost episode mea- sures in December. In February 2018, Dr. Parekh sent a letter to Acumen, LLC, the developer of the cost measure, urging Acumen to "exclude any FDA-approved Medicare Part B drug on pass- through status administered during cataract sur- gery from the cataract cost episode measure," stating that it would "disincentivize surgeons from using the drugs and negatively impact the utilization data CMS is collecting for this purpose." In September 2019, ASCRS and OOSS submitted comments to CMS regarding its 2020 Medicare Physician Fee Schedule pro- posed rule, which includes MIPS, "opposition to the continued inclusion of FDA-approved pass-through drugs in the cataract surgery episode-based cost measure," and encouraging CMS to "take immediate action to remove the current pass-through drug in the measure and set a policy to prevent any other pass-through References 1. "How the new 2019 MIPS cataract episode-based cost measure will impact you." Eye- World. 2019 June;24(6):22–24. 2. Process and Informa- tion Required to Determine Eligibility of Drugs, Biologicals, and Radiopharmaceuticals for Transitional Pass-Through Status under the Hospital Outpatient Prospective Payment System (OPPS). Centers for Medicare & Medicaid Services. https://www. cms.gov/Medicare/Medicare- Fee-for-Service-Payment/Hos- pitalOutpatientPPS/Downloads/ drugapplication.pdf. Accessed Nov. 4, 2019.

• Blank Page
• Blank Page (1)