WASHINGTON, Aug. 4-Medicare is about to announce that beginning in October it will start paying hospitals for use of the thrombolytic drug tissue plasminogen activator (tPA) for treatment of ischemic stroke, according to published reports.
The Centers for Medicare and Medicaid Services (CMS) will publish details of changes in Medicare part B payments for drugs in the Federal Register next week, reported the Wall Street Journal. That notice will inform hospitals of the new tPA-specific payment policy.
Currently, Medicare pays hospitals about $5,700 for treatment of ischemic stroke, but the proposed change would allow Medicare to pay hospitals roughly $6,000 more if tPA is used. The drug itself costs about $2,000, so there is potential for hospitals to boost revenues by using the thrombolytic -- a financial incentive that regulators suggest will improve care.
Nationally tPA is rarely used -- recent estimates are that just 2% of stroke patients get the drug. Cost is one factor that limits use, but a more important factor, according to stroke experts, is time. Few patients arrive at the hospital within the recommended three-hour treatment window. And, even if the patients arrive at the hospital within three hours, smaller hospitals often lack ready availability to CT scans and neurologists to confirm ischemia and rule out a hemorrhagic stroke.
Stroke experts claim that a change in Medicare reimbursement will increase access to the drug, but Genentech Inc., which makes the drug, said that while the change in payment policy confirms the importance of the drug it predicts the impact on use will be minimal.
The change in payment for tPA is part of a larger package of payment changes that CMS has been crafting since Congress passed the Medicare Modernization Act of 2003, which added a prescription drug benefit to Medicare. The law also requires Medicare to overhaul payment for injected and infused drugs, including tPA and others that are administered in hospitals, and chemotherapy drugs that are given in doctors' offices.
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