Cost of Effective Clot-Buster Drug Far Outpaces Reimbursement

Author(s):

While the cost of the widely used stroke clot-busting drug alteplase has more than doubled over the past decade, Medicare and Medicaid reimbursement has remained far behind.

The cost of the widely used stroke clot-busting drug tissue plasminogen activator (alteplase) has more than doubled over the past decade, but Medicare/Medicaid reimbursement has remained far behind, according to a study presented at the American Stroke Association’s International Stroke Conference 2016.

Between 2005 and 2014, the cost of alteplase increased by 111% but reimbursement from Medicare/Medicaid increased by only 8%, said the study’s lead author Dawn Kleindorfer, MD, of the University of Cincinnati in Ohio.

“Stroke healthcare professionals really need to be aware of the costs of the therapies they’re providing,” she said. “When the infrastructure is not adequately reimbursing, it should be a call to action for healthcare professionals to lobby the Centers for Medicare and Medicaid Services to better adjust for these higher-cost medications so we can take good care of our patients.”

Alteplase is the only FDA-approved drug for patients with stroke from a blocked blood vessel.

The study showed that in 2005, 1 mg of alteplase cost $30.50 compared with $64.30 in 2014. That means the standard 100-mg vial of alteplase cost about $6400 in 2014. The researchers noted that since the reimbursement to hospitals by Medicare/Medicaid increased by only 8% while the price rose 111%, roughly half of the reimbursement dollars now go to pay for the drug, while the other half covers “everything else” related to hospitalization, including diagnostic testing, bedside care, and other hospital costs. The cost was stable through 2009 but then began to rapidly increased, Dr Kleindorfer said.

She added that while the reason the cost of alteplase has gone up so much is not clear, reimbursement has not kept up with the cost because of the way calculations are done by Medicare/Medicaid, which is cutting hospital reimbursements on all levels.

“What we need to do is ensure that the reimbursement covers the cost of caring for these patients so that hospitals don’t lose money while providing this proven beneficial treatment,” Dr Kleindorfer said.

The study was limited by the use of average sales price from the drug’s manufacturer, which may vary between different hospitals. Reimbursement amounts from private insurers are also variable.