3. Non-opioid pain drug gets a payment bump
A new policy buried within Medicare’s large 2019 outpatient rule changes how the federal program will pay for Exparel, a non-opioid pain reliever used after surgeries, my colleague Bob Herman reports.
Starting next year, Medicare will add a 6% markup for Exparel if a patient gets the drug in a surgery center. Currently, Medicare pays for Exparel through a lower packaged rate.
Between the lines: Medicare's decision, which did not follow the advice of the Medicare Payment Advisory Commission, will boost revenue for Pacira Pharmaceuticals, the maker of Exparel.
- Pacira argued it deserved higher, separate payments for the drug because it could help steer people away from more addictive opioid painkillers.
- Pacira also registered lobbyists for the first time in April and spent $380,000 to lobby HHS on “improving access” to its drug.
- Since Medicare first proposed this policy change in July, Pacira’s stock has gone up 32%.
The big picture: Medicare officials did not approve higher pay for Exparel in hospital outpatient departments, but it’s still a big win for the company — especially in light of the fact that several experts say the drug is not worth its high price.