The cost of an effective, widely used clot-busting treatment has more than doubled during the past decade, but Medicare/Medicaid reimbursement lags far behind, according to new research presented at the American Stroke Association’s International Stroke Conference 2016.
“Stroke health care professionals really need to be aware of the costs of the therapies they’re providing,” said lead researcher Dawn Kleindorfer, MD, a professor in the neurology and rehabilitation department at the University of Cincinnati. “When the infrastructure is not adequately reimbursing, it should be a call to action for health care professionals to lobby the Centers for Medicare and Medicaid Services (CMS) to better adjust for these higher-cost medications so we can take good care of our patients.”
The only FDA-approved drug for patients with stroke from a blocked blood vessel is alteplase (Activase, Genentech), which contains recombinant tissue plasminogen activator (rtPA) proteins. When injected into a blocked blood vessel, these proteins break apart the blood clot and restore blood flow to the brain.
In a new study, researchers found that the cost of alteplase increased by 111% between 2005 and 2014. In 2005, 1 mg of the drug cost $30.50, compared with $64.30 in 2014. In other words, the standard 100-milligram vial of alteplase cost approximately $6,400 in 2014.
During the same period, the amount that the CMS reimbursed to hospitals for alteplase-treated patients increased by only 8%. What this means, according to the researchers, is that approximately half of the reimbursement dollars now go to pay for the drug, while the other half covers everything else related to hospitalization, including diagnostic testing, bedside care, and other hospital costs. For their analysis, the researchers used cost information that is publicly available on the CMS website.
“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.”
A limitation of the study is that it used the drug manufacturer’s average sales price, which may vary among hospitals. Another variable factor was the reimbursement amount from private insurers.
Stroke is the fifth-leading cause of death and the leading cause of disability in the U.S.
Source: American Heart Association; February 17, 2016.