Venom extract price seems stable for now

The ACAAI and American Academy of Allergy, Asthma & Immunology recognize that there are growing concerns among our members regarding venom immunotherapy related to recently announced changes in availability and pricing.

The Advocacy Council of the ACAAI extends a sincere thanks to all of you that responded to our call for help in obtaining venom invoices. We want to let you know that if price increases for venoms should occur, they will be a top priority for the Advocacy Council. However, after a careful review, it appears that any pending price hikes may have not yet been implemented and would not lead to reimbursement increases for 2019. Given that, we have decided to wait in asking CMS to review.  We may come back to you in a few months with another request for information on venom prices.

We understand your frustration with the current reimbursement for venom immunotherapy. Even though we were able to get a reimbursement increase of up to 31% for some of the venom immunotherapy codes beginning in 2017, we realize that this still barely covers the cost of the venom and, in some cases, may not cover it at all. This is largely due to Medicare’s reimbursement methodology that tends to disadvantage services that have high supply costs compared to those that require substantial physician work. We will closely track any venom price increases over the next few months and will address the issue with Medicare and other payers if appropriate.

Advocacy Issue: 
Billing, Coding & Payments