Hospital reimbursement for alteplase does not match up with increased costs

 - reimbursement

During the past decade, the cost of alteplase increased 111 percent, although reimbursement to hospitals for the clot-busting medication increased only 8 percent, according to an analysis.

Lead researcher Dawn Kleindorfer, MD, FAHA, professor in the neurology and rehabilitation department at the University of Cincinnati, presented the results in a poster presentation at the American Stroke Association’s International Stroke Conference on Feb. 17.

Kleindorfer and her colleagues evaluated publicly available data from the Centers for Medicare and Medicaid Services (CMS) and examined the quarterly CMS payment amounts per milligram of alteplase from Jan. 1, 2015, through July 1, 2014.

The researchers defined the CMS payment amounts as the manufacturer’s average sales price plus 6 percent until April 2014. After that, it was lowered to the manufacturer’s average sales price plus 4.3 percent. They then converted the CMS payment amounts to the manufacturer’s average sales price.

Alteplase is an FDA-approved tissue plasminogen activator intended to treat patients with acute ischemic stroke.

From January 2005 to October 2014, the cost of 1 mg of alteplase increased from $30.50 to $64.30, according to the researchers.

The base payment to hospitals for alteplase-treated stroke admissions increased 8 percent from $11,173 in 2006 to $12,064 in 2013. Meanwhile, the cost of alteplase increased from 27 percent of the payment in 2006 to 53 percent of the payment in 2013. During the time period of the study, the consumer price index increased 30.2 percent, according to the researchers.

“Stroke healthcare professionals really need to be aware of the costs of the therapies they’re providing,” Kleindorfer said in a news release. “When the infrastructure is not adequately reimbursing, it should be a call to action for healthcare professionals to lobby the Centers for Medicare and Medicaid Services to better adjust for these higher-cost medications so we can take good care of our patients.”

The researchers noted a few limitations, including that local drug prices may be different than the average prices used in the study. They added that they included base payments from CMS, which did not take into account regional and individual adjustments to hospitals.

“The reason the cost has gone up so much is unclear,” Kleindorfer said. “The reason that reimbursement has not kept up with the cost is complicated but has to do with the way it’s calculated and the fact that Medicare/Medicaid is cutting hospital reimbursements across the board. What we need to do is ensure that the reimbursement covers the cost of caring for these patients so that hospitals don’t lose money while providing this proven beneficial treatment.”