The 'CAP' is out of the bag; should you participate?

August 1, 2005

The interim final rules for the Competitive Acquisition Program (CAP), which goes into effect Jan. 1, 2006, have been published, although the final rules may not be published for 2 to 3 years.

I will try to give you an overview of CAP, discuss some of the surprises published in the interim rules, and your options for next year.

You have a choice. Keep that fact in mind as you read this article. In 2006 you will be able to continue to purchase all drugs under the average sales price (ASP) program, or you may voluntarily choose to participate in the CAP. The three biggest surprises are:

Your options

The big decision physicians must make is whether they're going to participate in the CAP or continue to buy all of their drugs through the ASP plus 6%. This decision must be made prior to Nov. 15, 2005. The enrollment period is Oct. 1 through Nov. 15. If you decide to participate, you must agree to obtain all available drugs for Medicare patients from a given vendor for 1 year. The second option, continuing to buy all drugs through the ASP plus 6%, will be automatic if you choose not to enroll in the CAP.

If you choose to participate in the CAP, you must sign a CAP election agreement, agree to provide all patients with a CMS-developed fact sheet on the program, and abide by all rules. The CAP vendor will provide only the specified drugs for Medicare patients. You will have to continue to buy all other drugs through the ASP plus 6%. In addition, you must buy all drugs for non-Medicare patients.

Among the rules participating physicians must abide by are the following: