Medicare encourages use of new technologies with pass-through provision

Omidria was recently made commercially available by Omeros Corporation. Omidria is formulated for dilution in standard irrigation solution used during cataract surgery or IOL replacement. This article discusses how Omidria is paid for by Medicare and what implications Medicare’s payment has for physicians.Medicare pays facilities — ASCs and hospital outpatient departments — for Omidria (phenylephrine 1% and ketorolac 0.3% injection) at average sales price plus 6%. This payment is separate from the payment for cataract procedures, which is intended to cover the procedure itself along with any associated drugs or supplies. Because of this additional payment for Omidria, the facility does not have to “eat” the cost within the amount Medicare pays for cataract surgery. The payment formula — average sales price plus 6% — is the same used for injectable drugs furnished in physicians’ offices.