Reimbursement for the use of stroke drug has not kept pace with cost: 3 things to know

The cost of tissue plasminogen activator (tPA), or alteplase, a clot-busting drug used to treat stroke patients, has doubled in the past decade, while reimbursement to hospitals for the use of tPA has not kept pace, researchers said this month at the American Stroke Association's 2016 International Stroke Conference, according to a report published by Neurology Today.

Here are three things to know about the issue, as outlined in the report.

1. The cost of tPA increased by 111 percent between 2005 and 2014, according to Dawn Kleindorfer, MD, a professor of neurology and rehabilitation at the University of Cincinnati, who presented an analysis of tPA costs at the conference. The analysis, which used quarterly data from CMS and the drug manufacturer's average sales price, found 1 milligram of the drug cost $30.50 in 2005, compared to $64.30 in 2014.

2. The base payment for tPA-treated stroke admissions increased 8 percent — from $11,173 to $12,064 — between 2006 and 2013, according to the report, while the cost of tPA went from 27 percent of the payment in 2006 to 53 percent in 2013. At the same time, according to the report, the CMS reimbursement to hospitals for tPA-treated patients increased by only 8 percent.

3. During the international stroke conference, Dr. Kleindorder said the price of tPA was stable through 2009, but then began to rapidly increase, according to the report. She did not pinpoint one specific reason for the rapid increase, according to the report, but did note the complexity involved. "The reason that reimbursement has not kept up with the cost is complicated, but has to do with the way it's calculated and the fact that Medicare/Medicaid is cutting hospital reimbursements across the board. 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. Kleindorder added.


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