Reimbursement mechanisms for glycoprotein IIb/IIIa-receptor inhibitors

Abstract

Changes in health care reimbursement policies as they apply to glycoprotein (GP) IIb/IIIa-receptor inhibitors are discussed. GP IIb/IIIa-receptor inhibitors significantly reduce the frequency of myocardial infarction and death in patients with non-ST- segment-elevation (NSTE) acute coronary syndromes (ACSs) and in those undergoing percutaneous coronary intervention (PCI). GP IIb/IIIa-receptor inhibitors are increasingly being used in ambulatory settings, such as the emergency department and the cardiac catheterization laboratory. Recent public policy decisions now provide appropriate reimbursement mechanisms for the outpatient use of GP IIb/IIIa-receptor inhibitors. As a result, small community hospitals and large tertiary care centers can both be appropriately reimbursed for these agents. In August 2000, the Center for Medicare and Medicaid Services developed the Ambulatory Payment Classification system. This system provides compensation for GP IIb/IIIa-receptor inhibitor acquisition and administration and is of special benefit to community hospitals. In addition, recent revisions to the inpatient prospective reimbursement (Diagnosis-Related Group) system increased payment for the use of an early aggressive (invasive) strategy in these patients. Together, these reimbursement mechanisms facilitate the early use of GP IIb/IIIa-receptor inhibitors in patients with NSTE ACSs and in those undergoing PCI. Recent policy changes facilitate reimbursement of hospitals for the use of GP IIb/IIIa-receptor inhibitors.