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Price Break Ahead for Fidaxomicin for C. Diff. Diarrhea


 

Hospitals will soon get a break on the price of fidaxomicin tablets for treatment of Clostridium difficile–associated diarrhea, thanks to a new add-on payment from Medicare.

Officials at the Centers for Medicare and Medicaid Services granted a new technology add-on payment for fidaxomicin tablets (Dificid) administered in the hospital. The new payment, which can be as high as $868 for a full course of the macrolide antibacterial drug, will begin on Oct. 1. The add-on payment is in addition to the standard Medicare payment for the treatment of C. difficile–associated diarrhea (CDAD).

CDC/D. Holdeman

The CMS included details about the add-on payment in the final regulation for the Inpatient Prospective Payment System.

Medicare typically only provides the add-on payment for new technologies associated with procedures, such grafts or stents. But after hearing about the clinical performance of the drug, Medicare officials agreed to grant the extra payment to hospitals. In the final rule, CMS officials wrote that the oral antibiotic has the potential "to decrease hospitalizations and physician office visits, and reduce the recurrence of CDAD, as well as to improve the quality of life for patients who have been diagnosed with CDAD."

The CMS provides add-on payments to hospitals to help subsidize the cost of treatments that are new and costly but that potentially offer a significant clinical benefit for Medicare beneficiaries. The payments are offered in addition to the standard DRG (diagnosis-related group) payment and can be up to 50% of the cost of the treatment for 2-3 years.

The CMS will issue guidance in the future on how hospitals can code to receive the add-on payment for Dificid.

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