Separate payment status for the use of the cataract surgery drug Omidria in ASCs expired Oct. 1, according to an update from Omeros Corp.
What you should know:
1. Congress approved a two-year extension of pass-through status for the drug in 2018. Now, Omeros Corp. is requesting that CMS and HHS confirm separate payment status for Omidria in ASCs for the fourth quarter.
2. Omeros sent CMS a comment letter on the proposed Outpatient Prospective Payment System/ASC Rule for 2021, as well as a legal opinion that the drug meets CMS' objective regulatory criteria for separate payment in ASCs.
3. Omeros and its advisers are "confident" that CMS is required by law to apply its separate payment policy for non-opioid pain management surgical drugs to Omidria in the fourth quarter, as well as in 2021. CMS is expected to address the issue before publishing its 2021 final rule around Nov. 1.
4. Omeros' Omidria (phenylephrine and ketorolac intraocular solution) 1 percent/0.3 percent is intended to help prevent intraoperative miosis during cataract surgery or intraocular lens replacement, as well as to reduce postoperative ocular pain.
5. Transitional pass-through payments are temporary payments meant to free HOPDs and ASCs to adopt new technology while Medicare collects cost data for determining a pay rate once the pass-through expires.