Pharmacy Question for the Week of November 13, 2017

Question:

Are there any changes for 2018 related to skin substitutes?

Answer:

As it did for 2017, the Centers for Medicare & Medicaid Services (CMS) will assign skin substitutes with a geometric mean unit cost (MUC) or a per-day cost (PDC) that exceeds either the MUC threshold or the PDC threshold to the high-cost group.

For 2018, it is establishing that a skin-substitute product that does not exceed either the 2018 MUC or PDC threshold, but was assigned to the high cost group for 2017, is assigned to the high cost group for 2018. The goal of its policy is to maintain similar levels of payment for skin substitute products for 2018 while it studies the current skin-substitute payment methodology to determine whether refinements to its existing methodologies may be warranted.