The Centers for Medicare & Medicaid Services (CMS) has granted a New-Technology Add-on Payment (NTAP, or add-on payment) for DIFICID® (fidaxomicin) tablets administered to inpatients at IPPS-participating hospitals to treat Clostridium difficile-associated diarrhea (CDAD). Introduced in 2001, the add-on payment is a special additional payment for qualifying Medicare Part A cases and is intended to assist in addressing cost as a barrier to appropriate use.
The add-on payment is designed to support timely access to innovative therapies used to treat Medicare beneficiaries in the inpatient setting that provide a substantial clinical improvement over existing therapies, and is only available to new technologies that meet three primary criteria established by CMS. These criteria require that:
CMS will pay hospitals an additional amount up to $868 per case in FY2013 when DIFICID is used to treat CDAD and the costs of the entire patient case exceed the Medical Severity Diagnostic Related Group (MS-DRG) payment amount. The $868 maximum payment may not apply to every case involving DIFICID. The policy is effective for hospital discharges occurring on or after October 1, 2012 and will continue for at least two years.
The maximum payment for FY 2014 has not yet been determined. DIFICID is the first and only oral medication not associated with a procedure code to apply and be approved for a NTAP. To learn more about the CMS NTAP ruling for DIFICID, visit www.NTAPDIFICID.com.