Pharmacy Question for the Week of June 4, 2018

Question:

I just started working for an ESRD facility, and I need to know how Medicare pays for hepatitis B vaccine and administration. Can you help?

Answer:

Hepatitis B vaccine and its administration (including staff time and supplies such as syringes) are paid to end-stage renal disease (ESRD) facilities in addition to, and separately from, the dialysis composite rate payment. Payment follows the same general principles that are applicable to any injected drug or biological.

Hospital-based facilities are paid for their direct and indirect costs on a reasonable-cost basis, and independent facilities are paid the lower of the actual charge or 95 percent of the average wholesale price (AWP). The allowance for injectables is based on the cost of the injectable and any supplies used for administration, plus a maximum $2 for the labor involved, if the facility’s staff administers the vaccine. In addition, the A/B MAC (A) makes an appropriate allowance for facility overhead.