Competitive Acquisition Program

Christian G. Downs, JD, MHA

Executive Director

Association of Community Cancer Centers

CAP

• No prescription drug coverage under the Medicare program

• Studies showed an overpayment for drugs

• MMA 2003 had several payment adjustments

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

CAP

• Available to physicians who administer drugs in their office under Part B

• Acquire drugs from vendors rather than purchase

• Program is voluntary

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

CAP

• A single national distribution area

• A single drug category for 181 drugs give “incident to”

• The physician/vendor enrollment process

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

CAP

• No change in coverage• No change in out of

pocket cost• CMS thinks that long

term costs could decrease somewhat

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

CAP

• Participation is voluntary• Physician enrolls with

vendor• Vendor delivers drug• Physician bills Medicare

for professional and administrative services

• Vendor bills Medicare for drug

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

CAP

• CMS has set out standards for vendors

• Vendor must then apply to Medicare program

• Vendor will be selected based on bid price

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

CAP

• Not going into effect until July of 2006

• Not popular with physicians as designed

• Not popular with vendors as designed

• Cost is issue attempting to be addressed

Overview

Background

Program Structure

Beneficiaries

Physician Participation

Vendor Selection

Conclusions

REMEMBER

• "One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors." -Plato

Christian G. Downs, JD, MHAExecutive Director

Association of Community Cancer Centers

(301) 984-9496 ext 220cdowns@accc-cancer.org