A change in Medicare payment rather than a "black box" warning from the Food and Drug Administration led to a decline in dialysis drug use, according to a BMC Nephrology study.
The FDA issued the warning in 2007 regarding anemia drugs — erythropoiesis-stimulating agents — stating they could increase the risk of stroke, heart attacks, blood clots and death. However, researchers found prescriptions didn't drop off sharply after the warning.
Instead, the use of ESAs experienced a slow, steady decline and was 30 percent lower than expected in 2011, according to the study. A change in Medicare payments for ESAs that eliminated fiscal incentives for higher doses led to the drop, according to the study's authors.
In January 2011, Medicare reformed its end-stage renal disease prospective payment system to bundle separately billable items into a larger dialysis composite rate. Under the new system, healthcare providers no longer have an incentive to use more drugs than clinically necessary, according to the study.
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