Re-naming and re-gaming: Medicare's doomed attempt to reform reimbursement for injectable drugs

Health Affairs

Volumn 23, Issue SUPPL. 2, 2004, Pages

  Kleinke, J D ^a,b,c  

^a Omnimedix Institute   (United States)

^b Health Strategies Network Inc   (United States)

^c Health Grades Inc   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DRUG;

DRUG COST; DRUG LEGISLATION; ECONOMIC EVALUATION; GOVERNMENT; HEALTH CARE POLICY; HUMAN; MEDICARE; PHYSICIAN; REIMBURSEMENT; REVIEW;

EID: 17144364369     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.W4.561     Document Type: Review

References (47)

1. R. Ball, "Perspectives on Medicare: What Medicare's Architects Had in Mind," Health Affairs 14, no. 4 (1995): 62-72; and M. Davis and S. Burner, "Three Decades of Medicare: What the Numbers Tell Us," Health Affairs 14, no. 4 (1995): 231-243.
2. R. Ball, "Perspectives on Medicare: What Medicare's Architects Had in Mind," Health Affairs 14, no. 4 (1995): 62-72; and M. Davis and S. Burner, "Three Decades of Medicare: What the Numbers Tell Us," Health Affairs 14, no. 4 (1995): 231-243.
3. P. Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982).
4. J. Robinson, "Theory and Practice in the Design of Physician Payment Incentives," Milbank Quarterly 79, no. 2 (2001): 149-177.
5. J.E. Calfee, "Hearing on Seniors' Access to Prescription-Drug Benefits," American Enterprise Institute for Public Policy Research, 15 February 2000, www.aei.org/news/newsID.17036/news_detail.asp (3 July 2004); and J. Hoff, Medicare Private Contracting: Paternalism or Autonomy (Washington: AEI Press, 1998).
6. J.E. Calfee, "Hearing on Seniors' Access to Prescription-Drug Benefits," American Enterprise Institute for Public Policy Research, 15 February 2000, www.aei.org/news/newsID.17036/news_detail.asp (3 July 2004); and J. Hoff, Medicare Private Contracting: Paternalism or Autonomy (Washington: AEI Press, 1998).
7. Strategies include DRGs for inpatient episodes, prospective payments for outpatient episodes and home health services, and the "least costly alternative" pricing system used for reimbursement for drugs within a therapeutic class.
8. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173), Section 303(b).
9. J.K. Iglehart, "The New Medicare Prescription-Drug Benefit - A Pure Power Play," New England Journal of Medicine 350, no. 8 (2004): 826-833.
10. "New Medicare drug benefit" is used here to express the colloquial interpretation of MMA, even though the majority of pages included in MMA relate not to prescription drugs but to a panoply of other health policy matters.
11. Iglehart, "The New Medicare Prescription-Drug Benefit."
12. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
13. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
14. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
15. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
16. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
17. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
18. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
19. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
20. Regarding physicians' prescribing patterns for injectable drugs, see Y. Kumarasamy et al., "Optimizing Antibiotic Therapy - the Aberdeen Experience," Clinical Microbiology and Infection 9, no. 5 (2003): 406-411; and L. Senn et al., "Improving Appropriateness of Antibiotic Therapy: Randomized Trial of an Intervention to Foster Reassessment of Prescription after Three Days," Journal of Antimicrobial Chemotherapy 53, no. 6 (2004): 1062-1067. Regarding the tendency of physicians to prescribe higher-cost drugs in general, see J. Shapiro, "Prescriptions: How Your Doctor Makes the Choice," U.S. News and World Report, 19 February 2001; and R.S. Parker and C.E. Pettijohn, "Ethical Considerations in the Use of Direct-to-Consumer Advertising and Pharmaceutical Promotions: The Impact on Pharmaceutical Sales and Physicians," Journal of Business Ethics 48, no. 3 (2003): 279-290. Regarding drug market pricing inefficiencies, see J.P. Newhouse, "How Much Should Medicare Pay for Drugs?" Health Affairs 23, no. 1 (2004): 89-102; R.G. Frank, "Prescription Drug Prices: Why Do Some Pay More than Others Do?" Health Affairs 20, no. 2 (2001): 115-128; and Shapiro, "Prescriptions." Regarding marketing messages to providers, see Parker and Pettijohn, "Ethical Considerations"; and M.M. Chren and C.S. Landefeld, "Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary," Journal of the American Medical Association 271, no. 9 (1994): 684-689.
21. D. Gencarelli, "Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?" Issue Brief no. 775 (Washington: National Health Policy Forum, June 2002); B. Martinez, "Drug-Price Surge May Erode Savings from Medicare Card," Wall Street Journal, 24 March 2004; and M. Freudenheim, "Employers to Form 'Buyers Club' Seeking Low Drug Prices," New York Times, 11 June 2004.
22. D. Gencarelli, "Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?" Issue Brief no. 775 (Washington: National Health Policy Forum, June 2002); B. Martinez, "Drug-Price Surge May Erode Savings from Medicare Card," Wall Street Journal, 24 March 2004; and M. Freudenheim, "Employers to Form 'Buyers Club' Seeking Low Drug Prices," New York Times, 11 June 2004.
23. D. Gencarelli, "Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?" Issue Brief no. 775 (Washington: National Health Policy Forum, June 2002); B. Martinez, "Drug-Price Surge May Erode Savings from Medicare Card," Wall Street Journal, 24 March 2004; and M. Freudenheim, "Employers to Form 'Buyers Club' Seeking Low Drug Prices," New York Times, 11 June 2004.
24. Prior to MMA's passage, Congress attempted on several occasions to change CMS reimbursement rates pegged to AWP. Each attempt was thwarted by ferocious lobbying from physician specialty societies.
25. C. Roskey, "MMA Falls Short of Modernizing 'Dinosaur' ESRD Payment System," BNA Medicare Report 15, no. 13 (2004); T.R. Oliver, P.R. Lee, and H.L. Lipton, "A Political History of Medicare and Prescription Drug Coverage," Milbank Quarterly 28, no. 2 (2004): 283-354; M. Moon, "How Beneficiaries Fare under the New Medicare Drug Bill," Issue Brief (New York: Commonwealth Fund, June 2004); and R.E. Hurley, B.C. Strunk, and J.M. Grossman, "Preferred Provider Organizations and Medicare: Is There an Advantage?" Issue Brief, April 2004, www.hschange.org/CONTENT/671 (3 July 2004).
26. C. Roskey, "MMA Falls Short of Modernizing 'Dinosaur' ESRD Payment System," BNA Medicare Report 15, no. 13 (2004); T.R. Oliver, P.R. Lee, and H.L. Lipton, "A Political History of Medicare and Prescription Drug Coverage," Milbank Quarterly 28, no. 2 (2004): 283-354; M. Moon, "How Beneficiaries Fare under the New Medicare Drug Bill," Issue Brief (New York: Commonwealth Fund, June 2004); and R.E. Hurley, B.C. Strunk, and J.M. Grossman, "Preferred Provider Organizations and Medicare: Is There an Advantage?" Issue Brief, April 2004, www.hschange.org/CONTENT/671 (3 July 2004).
27. C. Roskey, "MMA Falls Short of Modernizing 'Dinosaur' ESRD Payment System," BNA Medicare Report 15, no. 13 (2004); T.R. Oliver, P.R. Lee, and H.L. Lipton, "A Political History of Medicare and Prescription Drug Coverage," Milbank Quarterly 28, no. 2 (2004): 283-354; M. Moon, "How Beneficiaries Fare under the New Medicare Drug Bill," Issue Brief (New York: Commonwealth Fund, June 2004); and R.E. Hurley, B.C. Strunk, and J.M. Grossman, "Preferred Provider Organizations and Medicare: Is There an Advantage?" Issue Brief, April 2004, www.hschange.org/CONTENT/671 (3 July 2004).
28. C. Roskey, "MMA Falls Short of Modernizing 'Dinosaur' ESRD Payment System," BNA Medicare Report 15, no. 13 (2004); T.R. Oliver, P.R. Lee, and H.L. Lipton, "A Political History of Medicare and Prescription Drug Coverage," Milbank Quarterly 28, no. 2 (2004): 283-354; M. Moon, "How Beneficiaries Fare under the New Medicare Drug Bill," Issue Brief (New York: Commonwealth Fund, June 2004); and R.E. Hurley, B.C. Strunk, and J.M. Grossman, "Preferred Provider Organizations and Medicare: Is There an Advantage?" Issue Brief, April 2004, www.hschange.org/CONTENT/671 (3 July 2004).
29. Roskey, "MMA Falls Short."
30. See M. Hawryluk, "Medicare Hopes to Boost Better Option for Dialysis," American Medical News, 17 May 2004, www.ama-assn.org/amednews/ 2004/05/17/gvsb0517.htm (5 July 2004); and MMA Section 623(a).
31. Most ESRD patients undergo hemodialysis (the standard treatment method) and receive one dose of erythropoietin as part of the procedure. See D. Gellene, "Medicare Agency Questions Anemia Drug's Cost, but Increased Use Is Urged," Los Angeles Times, 11 May 2004. See also National Kidney Foundation, "A to Z Health Guide," 3 June 2004, www.kidney.org/atoz/ atozItem.cfm?id=39 (20 July 2004).
32. Most ESRD patients undergo hemodialysis (the standard treatment method) and receive one dose of erythropoietin as part of the procedure. See D. Gellene, "Medicare Agency Questions Anemia Drug's Cost, but Increased Use Is Urged," Los Angeles Times, 11 May 2004. See also National Kidney Foundation, "A to Z Health Guide," 3 June 2004, www.kidney.org/atoz/ atozItem.cfm?id=39 (20 July 2004).
33. R. Pear and R. Toner, "A Final Push in Congress: The Overview; Sharply Split, House Passes Broad Medicare Overhaul; Forceful Lobbying by Bush," New York Times, 23 November 2003.
34. According to comments about MMA made by Joseph Bailes during the 2004 annual meeting of the American Society of Clinical Oncologists, 6 June 2004. See also the American College of Rheumatology's appeal to CMS administrator Mark McClellan, www.rheumatology.org/advocacy/federal/followup0504.pdf (20 July 2004); "Questions on Physician Reimbursement Formula," Renal Policy Express, May 2004; and Renal Physicians Association, "RPA Urges Congressional Mandate for Demonstration Project to Assess Impact of Medicare Fee Schedule Dialysis Proposals," www.renalmd.org/publications/downloads/ FinalMFSDEMONSTRATIONPROJECT.pdf (20 July 2004).
35. According to comments about MMA made by Joseph Bailes during the 2004 annual meeting of the American Society of Clinical Oncologists, 6 June 2004. See also the American College of Rheumatology's appeal to CMS administrator Mark McClellan, www.rheumatology.org/advocacy/federal/followup0504.pdf (20 July 2004); "Questions on Physician Reimbursement Formula," Renal Policy Express, May 2004; and Renal Physicians Association, "RPA Urges Congressional Mandate for Demonstration Project to Assess Impact of Medicare Fee Schedule Dialysis Proposals," www.renalmd.org/publications/downloads/ FinalMFSDEMONSTRATIONPROJECT.pdf (20 July 2004).
36. According to comments about MMA made by Joseph Bailes during the 2004 annual meeting of the American Society of Clinical Oncologists, 6 June 2004. See also the American College of Rheumatology's appeal to CMS administrator Mark McClellan, www.rheumatology.org/advocacy/federal/followup0504.pdf (20 July 2004); "Questions on Physician Reimbursement Formula," Renal Policy Express, May 2004; and Renal Physicians Association, "RPA Urges Congressional Mandate for Demonstration Project to Assess Impact of Medicare Fee Schedule Dialysis Proposals," www.renalmd.org/publications/downloads/ FinalMFSDEMONSTRATIONPROJECT.pdf (20 July 2004).
37. MMA, Section 303(b).
38. Ibid., Section 303(a).
39. I b i d.
40. Ibid., Section 303(d).
41. The Red Book is published annually by Thomson PDR.
42. Roskey, "MMA Falls Short."
43. The industry is dominated by four providers, Gambro, DaVita, Fresenius Medical Care AG, and Renal Care Group, which in the aggregate control 62 percent of the dialysis market, according to "Dialysis: Slipping Margins, Solid Business," Health Leaders, July 2001, www.healthleaders.com/magazine/ feature1.php?contentid=25901 (5 July 2004). The remainder of the market is served by local, usually independent hospitals and physician practices.
44. MMA, Section 623(d).
45. I b i d.
46. I b i d.
47. "Medicare Reform to Shake Up Oncologists, May Lead to New Specialty Pharmacy Pacts," Specialty Pharmacy News, January 2004, www.aishealth.com/DrugCosts/specialty/spnMedicareReform.html (8 July 2004).