Immunizations & injectable rates unchanged

Immunization and injectables rates unchanged through 2009 despite lawsuit

(Oct. 27, 2009) - Earlier this year a U.S. Federal District Court granted final approval of the settlement of a lawsuit that alleged in 2002, two drug companies manipulated Average Wholesale Price (AWP) amounts to increase steeply. The court concluded that this increase caused millions of consumer and third-party payers, including Priority Health, to pay drug prices that were unnecessarily and artificially inflated.

As a result:

• Drug companies have been ordered to decrease the AWPs for more than 400 common drugs, including immunizations and other injectables.
• Priority Health will be updating AWP prices impacted by this lawsuit on Jan. 1, 2010.

We will maintain current pricing

The impact of this change may significantly decrease reimbursement amounts to primary care providers. However, we will maintain current pricing on any immunization and injectables, including those priced at ASP (Average Sale Price), through Dec. 31, 2009.

Here's why we are protecting providers from financial impact of lawsuit:

• We're committed to giving our providers adequate notification of fee schedule changes.
• We know our providers have stocked these drugs based on an inflated AWP amount, and we believe reimbursement rates should be aligned with costs. As drugs are re-ordered, lower prices will be effective.
• We're committed to strengthening provider partnerships to improve performance, increase value and support growth.

The next reimbursement rate update will occur as scheduled in January 2010.