• Academy Moves to Stem WPS’ Bad Avastin Claims Policy


    One Medicare carrier’s new Avastin policy is drawing the Academy’s attention for all the wrong reasons. WPS Health Solutions is now requesting physicians provide an Avastin invoice to receive payment for administering the drug. 

    The policy is slowing the reimbursement process and has practices scratching their heads, since the drug is typically purchased from outsourcing facilities in batches, not for individual patients. The Academy is in direct contact with WPS to fight this onerous policy, which is adding another burden to practices. 

    It is our latest action to ensure ongoing access and fair reimbursement for Avastin. We’re also collecting data on price and availability from pharmacies and educating Medicare administrative contractors with the goal of securing recognition of the drug’s increased costs. 

    WPS’ claims instructions for Avastin injections is effective with claims processed on or after Aug. 5, 2019, and for dates of service on or after June 11, 2019. WPS says it is using invoice pricing for bevacizumab for intravitreal injections, but it is not clear if or how much additional reimbursement will be provided to cover the increased cost of handling such drugs.