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Centers for Medicare and Medicaid Propose New Reimbursement for EXPAREL in All Outpatient Surgical Environments Beginning January 1, 2025
-- Proposed Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Rule extends separate payment from ambulatory surgical
About this update from Pacira Biosciences, Inc.
[{"type":"text","content":"-- Proposed Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment System Rule extends separate payment from ambulatory surgical centers to include the hospital outpatient environment – -- Rule implements the NOPAIN Act, signed into law as part of the Consolidated Appropriations Act of 2023 -- TAMPA, Fla., July 10, 2024 (GLOBE NEWSWIRE) -- Pacira BioSciences, Inc. (NSDQ: PCRX), the industry leader in its commitment to non-opioid pain management and regenerative health solutions, today announced that the Centers for Medicare and Medicaid Services (CMS) has issued its proposed Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule for 2025. In the proposed rule, EXPAREL® (bupivacaine liposome injectable suspension) is one of six covered non-opioids—two of which are specific to ophthalmology— qualifying for separate Medicare reimbursement in both the ambulatory surgical center (ASC) and hospital outpatient (HOPD) settings. Pending finalization, this policy would go into effect beginning January 1, 2025. The proposed rule reflects impending implementation of the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which mandates separate CMS payment for qualifying non-opioid drugs and devices across HOPD and ASC settings. The law was passed as part of the Consolidated Appropriations Act of 2023. “Following several years of advocacy for reimbursement policy reform to allow increased patient and provider access to non-opioids, we are pleased to see EXPAREL included as one of only six qualifying non-opioid drugs to treat postsurgical pain in the proposed rule,” said Frank D. Lee, Chief Executive Officer of Pacira. “As the only covered single-dose product approved for both local and regional analgesia across surgical procedures, we believe this new reimbursement—pending finalization—will offer clinicians increased ability to utilize a best-in-class option for achieving long-lasting non-opioid pain control with an increased ability to transition to the outpatient environment.” Proposed Medicare payment rates for covered non-opioid drug products—as outlined in the proposed rule—equate to average sales price (ASP) + 6% in the HOPD and ASC environments. The six products and associated reimbursement rates included in the rule are as follows: Non-Opioid DrugProposed Separ...