Approved CAP Vendor

BioScrip, Inc. is the Approved CAP Vendor for the Competitive Acquisition Program (CAP) for certain Part B drugs and biologicals through December 31, 2008.  The CAP is postponed for 2009.  Additional information about the 2009 CAP postponement may be found on the "Overview" page and the "Information for Physicians" page.

CAP Claims Submission Deadlines and Unused CAP Drugs

The following is a reminder about upcoming CAP deadlines.  It is very important that physicians who participated in the CAP during 2008 understand and comply with these deadlines because failure to do so will affect physicians' ability to be reimbursed.

CAP Drugs Administered During 2008

• All CAP drug claims must be submitted on or before January 30, 2009.  CAP drug claims and corresponding physicians' drug administration claims must have a date of service on or before December 31, 2008.
• CAP drugs that have not been administered by December 31, 2008 are the property of the Approved CAP Vendor.
• Do not submit CAP claims for dates of service after December 31, 2008 because they will be denied. 
• CAP claims submitted by the Approved CAP Vendor for dates of service after December 31, 2008 will also be denied.

CAP Drugs NOT Administered by December 31, 2008

• CAP physicians must return any unused CAP drugs to the Approved CAP Vendor by February 28, 2009. 
• CAP drugs are the property of the Approved CAP Vendor. Therefore, physicians who have not returned these drugs to the Approved CAP Vendor on or before February 28, 2009 will be liable for the cost of drugs.   
• Please note that CAP physicians may contact the Approved CAP Vendor to discuss the option of purchasing unused CAP drugs. 

Emergency Restocking of CAP Drugs for Dates of Services on or before December 31, 2008

• When permitted under the emergency restocking provision, physicians may submit a prescription order for a CAP drug to replace what they used from their own stock. Physicians may request replacement drugs ONLY if the date of service is on or before December 31, 2008, AND the corresponding drug administration claim has been submitted on or before January 30, 2009.
• Physicians must request replacement drugs by January 30, 2009.
• The Approved CAP Vendor will not send replacement products under the CAP emergency restocking provision (J2 modifier claims) after February 28, 2009.
• CAP physicians who have not submitted a prescription order and a request for replacement drugs under the emergency restocking provision as described above will not be able to bill Medicare under the ASP system for the CAP drugs that they administered on or before December 31, 2008 from their private stock.

For more information

Physicians who participated in the CAP during 2008 are encouraged to contact the Approved CAP Vendor and reconcile their inventories as soon as possible.  Contact information for the Approved CAP Vendor, BioScrip, is available on their website, which can be accessed via the 'Related Links Outside CMS' section below, or on the CAP "Approved CAP Vendor" page (see link in the menu to the left).

Drugs Supplied Under the CAP

Lists of drugs supplied by the approved CAP vendor for each quarter of the CAP appear in the 'Downloads' section below. The lists include the specific NDCs that the vendor supplies.

Approved CAP Vendors may request the addition of new drugs to their CAP drug lists.  Written requests for changes must be submitted to CMS and the CAP designated carrier.  If CMS determines that the new drug is appropriate for inclusion on the Approved CAP Vendor's drug list, changes will become effective in a subsequent quarter.  Requests for additions to the CAP drug list must be submitted at least 4 months prior to the desired effective date.

Other Vendor Information

BioScrip's Vendor Identification Number (VIN) is Q103.

A link to BioScrip's website which contains contact information for the CAP is in the Related Links Outside CMS section below.

The address that a local carrier or MAC should use for correspondence related to appeals and BR 5207.7.2 is:

    BioScrip, Inc.
    Attention: CAP Department
    2791 Charter Street
    Columbus OH  43228

The CAP NOC drug list identifies drugs which an approved CAP vendor may request to have added to the list of drugs that the vendor supplies under the CAP. Drugs on the CAP NOC drug list are not available through the CAP until requested by an approved CAP vendor, cleared by CMS, and placed on the list of drugs supplied by a CAP vendor. The CAP NOC drug list appears in the Downloads section below.

Billing of CAP Coinsurance to Beneficiaries with no Supplemental Insurance

A Question and Answer (Q&A) document on this subject is posted in the Downloads section below.

For updated information about the physician election period, click on the "Information for Physicians" link on the left margin of the page.

CAP Vendor Qs & As

Qs & As about the post payment review process authorized by the Tax Relief and Health Care Act of 2006 (TRHCA) and the collection of beneficiary cost sharing amounts appear in the Downloads section below.

2008 Medicare Part B Drug CAP Payment Amount Update

The payment amounts for CAP drugs were initially based on bids submitted for each drug by potential vendors during the bidding process. The payment amounts were updated for 2008 based on the change in the reasonable net acquisition cost (RNAC) incurred for acquiring CAP drugs.

• The percent change in RNAC for 2008 was calculated based on vendor-supplied data. This percent change in RNAC was also used as a proxy for the percent change in RNAC for vendors that initially bid but are not in the CAP program.
• The updated payment amounts were calculated based on the average of the bid prices as adjusted by the percent change in RNAC.

The updated CAP payment amount for all weighted drugs in the CAP category is limited by the weighted ASP payment amount across those drugs in the category. Therefore some individual weighted CAP drugs may be paid at amounts greater that ASP+6%, but the overall weighted payment amount is limited at ASP+6%. The CAP payment amount limit for each unweighted drug equals the ASP payment amount.

The 2008 CAP payment amounts are effective from 1/1/2008 until 12/31/2008.