Competitive acquisition program had a good premise but plan halted

Key Points

Washington, DC-After 2 years, the federal government's voluntary Competitive Acquisition Program (CAP) has been put on hold as of January.

Under the CAP program, physicians could order approximately 181 drugs for free from government-chosen vendor BioScript Inc., eliminating the need for doctors to maintain an expensive drug inventory. Medicare paid the vendor for the drugs and billed patients.

The program had many administrative problems, however, according to George Williams, MD, board member of the American Academy of Ophthalmology and chairman of the Department of Ophthalmology at William Beaumont Hospital in Royal Oak, MI.

"The impact of ending the CAP program will be limited because few ophthalmologists are now participating," Dr. Williams said. "Of those that did participate, many found the program to be unworkable for a variety of logistical issues."

In theory, the program should have lessened the financial burden for physicians.

"The benefit of the program was that it had the potential to get ophthalmologists out of the drug delivery business and avoid substantial economic risks of using expensive drugs," he said.

The program, however, was inflexible with too many restrictions, according to Dr. Williams. For example, CAP drugs could be administered only in the offices to which they were delivered, placing a burden on practices with more than one office. Also, CAP drugs could be ordered only for a specific patient and could not be stored for future use, requiring patients to return. Vendor BioScript did not provide same-day delivery, and afternoon orders could take 2 days to arrive.

Not many ophthalmologists are affected by the halt of the program, as only 4,200 physicians nationwide participated. CMS said that it will improve CAP before the program resumes.

"The original premise was a good idea-to get doctors out of the drug delivery business," he said. "The fatal flaws were in the execution of the program, which, in the end, created more problems than benefits for both ophthalmologists and patients."

Amanda Brower is senior editor with the Centralized Content Group at Advanstar Communications, publisher of Ophthalmology Times.