News for your practice
- Medicare now pays for enoxaparin administered in outpatient settings
- New CDC guide to smallpox vaccination has photos of normal and adverse reactions
Thanks in part to the efforts of ACP-ASIM chapter leaders, Medicare now pays for the administration of enoxaparin, a low molecular weight heparin used for short-term outpatient treatment of venous thrombosis.
Medicare recently issued new guidelines requiring carriers to re-evaluate whether biologicals and drugs are usually administered in physicians' offices. A federal law passed in December 2000 mandates Medicare coverage of biologicals and drugs that beneficiaries usually do not self-administer. This expands coverage for drugs, replacing old language in the law that stated that Medicare covers "drugs and biologicals which cannot... be self-administered."
Although many Medicare carriers began covering enoxaparin after the law was passed, several carriers expressed reservations about the change. Leaders from several College chapters persuaded them that enoxaparin meets Medicare's coverage criteria.
College leaders pointed out that studies have demonstrated that most Medicare patients do not actually administer the drug themselves. They explained that because enoxaparin is usually administered by a medical professional to treat an acute condition, Medicare must reimburse physicians for administering it.
Every Medicare carrier maintains a list of drugs they consider "usually self-administered" and, therefore, not covered. To be covered under the new guidelines, drugs must be administered for an acute condition (lasting less than two weeks) and be self-administered less than 50% of the time.
Physicians can challenge carrier drug coverage decisions by mailing literature supporting their position to their Medicare carrier's medical director.
A list of Medicare carriers' addresses is online.
The CDC has developed a pocket guide on smallpox vaccination that features images of normal and adverse reactions to the vaccine.
The reference guide provides step-by-step instructions and photographs on how to administer the vaccine with a bifurcated needle. It also provides images detailing a successful "take" of the vaccine, as well as images and descriptions of the major adverse events associated with the vaccine.
Information on how to obtain copies of the guide from your state health department is online.
For more smallpox information, see the College's Bioterrorism Resource Center.
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