Outpatient Surgery Magazine - Subscribers

COVID-19 Crisis - Outpatient Surgery Magazine - April 2020

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/1234932

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Page 84 of 114

case. Omidria's pass-through status expires on Oct. 1. Lobbying efforts by the product's manufacturer could result in another new pass- through period or establish a permanent separate reimbursement. • Dextenza is a corticosteroid insert placed by the surgeon to treat post-operative pain by delivering a tapered dose of dexamethasone for 30 days. It costs approximately $572 per insert with a pass-through status that runs until the end of 2021. • Dexycu (dexamethasone) 9% is an extended-release steroid deliv- ered with a single injection that is designed to decrease post-op inflammation. It costs about $696 per case and its pass-through status also runs until the end of 2021. These medications can decrease the usage of postoperative drops, thereby decreasing the need for patient compliance and improving out- comes. The significant price of these medications makes them cost-prohibi- tive in a specialty with slim profit margins, but the pass-through status lets your facility bill Medicare separately for the per-case cost plus 6%. Congress created pass-through payments to ensure innovative new drugs, devices and biological agents are available for patients and paid for separately from a facility's or physician's bundled payment. While the cost may seem large relative to the facility fee, this is a mere fraction of what CMS has set aside for pass-through products. CMS, not the drug manufacturer, determines the price of these med- ications through a complex formula that they use for all pass-through products. If these medications don't obtain approval from CMS when their pass-through statuses expire, they will be considered "packaged" and will no longer be reimbursed separately, likely severely limiting patient access to these innovative medications. The pot of money that CMS sets aside each year for pass-through A P R I L 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 8 5

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