Drug Spreadsheet Nurse by had19510

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									ASCO ANALYSIS OF 2005 MEDICARE DRUG PAYMENT RATES

Thank you for taking the time to provide data on drugs purchased by your practice. To enhance ASCO's ability to analyze the detailed
information you provide in the chart below, we request that you also respond to the following brief set of questions. Please be assured
that all submissions will be de-identified and kept confidential.
                                        Question                                             Response
1. How many FTE physicians are there in the practice for which data is being reported?

2. How many FTE mid-level providers (nurse practitioners, clinical nurse practitioners,
physicians' assistants) are there in the practice for which data is being reported?

3. Does your practice purchase any drugs through group purchasing organizations
(GPOs)?
4. If you answered "yes" to Question 3, please indicate the estimated percentage (by
dollars) of the drugs purchased by your practice that are acquired through GPOs.
5. What percentage of your total practice revenue comes from Medicare?

6. Does your practice pay a sales or gross receipts tax on drugs?

7. If you answered "yes" to Question 6 please indicate the percentage tax you pay on
drugs.




   A                 B                 C            D               E            F        G            H             I
                                                        Put an "X"
                                                                                                          Price you
                                                         here if you
                                                                                                       expect to pay                        Total
                                                       expect rebates                                                   Units you
                                                                                                      on Jan. 1, 2005                   estimated Q1
                                                        or discounts                  Jan-Mar 2005                    billed (for all
                                                                      2004 Medicare                     (consider all                   2005 revenue
                                                        on this drug                    Medicare                      payers) in Q3
                                                                         payment                       discounts and                    (assuming Q3
                                                        that are not                    payment                       2004 (July 1 -
                                                                                                        rebates that                         2004
                                                         included in                                                     Sept 30)
                                                                                                           you can                       utilization)
                                                       the Column G
                                                                                                      calculate now)
                                                            price

HCPCS               Drug                    Unit

J0640   Injection, leucovorin calcium         50 mg                           $3.00           $1.30                                             $0.00

J0696   Injection, ceftriaxone sodium        250 mg                          $13.35           $6.57                                             $0.00

J0780   Injection, prochlorperazine      up to 10 mg                          $3.74           $3.01                                             $0.00
J0880   Injection, darbepoetin alfa            5 mcg                         $21.20          $17.72                                             $0.00
        Injection, dexamethasone
J1094   acetate                                1 mg                           $0.64           $0.25                                             $0.00
        Injection, dexamethosone
J1100   sodium phosphate                       1 mg                           $0.10           $0.14                                             $0.00
        Injection, diphenhydramine
J1200   HCl                              up to 50 mg                          $1.43           $0.94                                             $0.00

J1260   Injection, dolasetron mesylate        10 mg                          $13.85           $6.61                                             $0.00
J1440   Injection, filgrastim (G-CSF)       300 mcg                         $158.50         $178.94                                             $0.00
J1441   Injection, filgrastim (G-CSF)       480 mcg                         $267.79         $282.41                                             $0.00
        Injection, immune globulin,
J1563   intravenous                              1g                          $66.00          $56.72                                             $0.00
J1564   Injection, immune globulin            10 mg                           $0.72           $0.57                                             $0.00
J1626   Injection, granisetron HCl          100 mcg                          $15.62           $7.09                                             $0.00
J1645   Injection, dalteparin sodium        2500 IU                          $14.04           $9.92                                             $0.00
J1650   Injection, enoxaparin sodium        10 mg       $5.46       $5.15    $0.00
J1655   Injection, tinzaparin sodium      1000 IU       $3.43       $2.60    $0.00
J1750   Injection, iron dextran             50 mg      $16.03      $11.06    $0.00
J1956   Injection, levofloxacin            250 mg      $18.62       $7.64    $0.00
J2060   Injection, lorazepam                 2 mg       $2.81       $1.27    $0.00
J2353   Injection, octreotide depot          1 mg      $77.14      $85.39    $0.00
        Injection, octreotide, non-
J2354   depot                              25 mcg       $3.81       $4.67    $0.00
J2355   Injection, oprelvekin                5 mg     $239.67     $243.35    $0.00
J2405   Injection, ondansetron HCl           1 mg       $5.58       $3.73    $0.00
        Injection, pamidronate
J2430   disodium                            30 mg      $237.88      $59.06   $0.00
J2505   Injection, pegfilgrastim             6 mg    $2,507.50   $2,273.93   $0.00

J2550   Injection, promethazine HCl    up to 50 mg      $2.55       $2.15    $0.00
        Injection, metoclopramide
J2765   HCl                            up to 10 mg      $1.67       $0.45    $0.00
J2780   Injection, ranitidine HCl            25 mg      $1.29       $0.93    $0.00

J2792   Rho(D) immune globulin h, sd                   $18.39      $13.40    $0.00
        Injection, sargramostim (GM-
J2820   CSF)                               50 mcg      $24.47      $21.67    $0.00
        Injection, sodium ferric
        gluconate complex in sucrose
J2916   injection                        12.5 mcg       $7.31       $4.83    $0.00
J3487   Injection, zoledronic acid           1 mg     $194.54     $198.39    $0.00
J9000   Doxorubicin HCI                     10 mg       $8.16       $4.25    $0.00
        Doxorubicin HCI, all lipid
J9001   formula                             10 mg     $352.06     $356.35    $0.00
J9010   Alemtuzumab                         10 mg     $523.00     $511.48    $0.00
                                        single use
J9015   Aldesleukin                           vial    $657.15     $672.06    $0.00
J9017   Arsenic trioxide (Trisenox)          1 mg      $32.94      $33.30    $0.00
                                           10,000
J9020   Asparaginase                         units     $56.02      $54.52    $0.00
        BCG live (intravesical), per
J9031   instillation                                $143.28     $118.41    $0.00
J9040   Bleomycin sulfate               15 units    $150.61      $55.01    $0.00
J9045   Carboplatin                      50 mg      $135.15     $125.47    $0.00
J9050   Carmustine                      100 mg      $121.84     $139.10    $0.00

J9060   Cisplatin, powder or solution    10 mg       $13.56       $4.96    $0.00
J9062   Cisplatin                        50 mg       $67.79      $18.37    $0.00
J9065   Injection, cladribine             1 mg       $45.90      $43.29    $0.00
J9070   Cyclophosphamide                100 mg        $5.13       $2.34    $0.00
J9080   Cyclophosphamide                200 mg        $9.74       $4.69    $0.00
J9090   Cyclophosphamide                500 mg       $20.45      $13.91    $0.00
J9091   Cyclophosphamide                    1g       $40.92      $23.43    $0.00
J9092   Cyclophosphamide                    2g       $81.82      $46.86    $0.00
        Cyclophosphamide,
J9093   lyophilized                     100 mg        $5.21       $0.60    $0.00
        Cyclophosphamide,
J9094   lyophilized                     200 mg       $10.41       $1.21    $0.00
        Cyclophosphamide,
J9095   lyophilized                     500 mg       $20.45       $3.02    $0.00
        Cyclophosphamide,
J9096   lyophilized                         1g       $40.92       $6.04    $0.00
        Cyclophosphamide,
J9097   lyophilized                         2g       $83.95      $12.08    $0.00
J9098   Cytarabine liposome                         $332.35     $350.45    $0.00
J9100   Cytarabine                      100 mg        $7.33       $1.68    $0.00
J9110   Cytarabine                      500 mg        $7.65       $8.38    $0.00
J9120   Dactinomycin                     0.5 mg      $12.41      $12.07    $0.00
J9130   Dacarbazine                     100 mg       $10.04       $5.29    $0.00
J9140   Dacarbazine                     200 mg       $19.47      $11.25    $0.00
J9150   Daunorubicin HCl                  10 mg      $66.42      $27.42    $0.00
        Daunorubicin citrate,
J9151   liposomal furmulation             10 mg       $57.80      $55.99   $0.00
J9160   Denileukin diftitox             300 mcg    $1,190.85   $1,205.53   $0.00
J9170   Docetaxel                         20 mg      $301.40     $297.58   $0.00
J9178   Injection, epirubicin HCl          2 mg       $24.73      $25.41   $0.00
J9181   Etoposide                         10 mg        $1.53       $0.45   $0.00
J9182   Etoposide                           100 mg        $15.30       $4.51    $0.00
J9185   Fludarabine phosphate                 50 mg      $318.59     $272.09    $0.00
J9190   Fluorouracil                        500 mg         $1.85       $1.68    $0.00
J9200   Floxuridine                         500 mg       $122.40      $71.39    $0.00
J9201   Gemcitabine HCl                     200 mg       $111.33     $115.34    $0.00
J9202   Goserelin acetate implant            3.6 mg      $375.99     $189.79    $0.00
J9206   Irinotecan                            20 mg      $130.24     $125.58    $0.00
J9208   Ifosfamide                               1g      $134.55      $62.04    $0.00
J9209   Mesna                               200 mg        $31.45      $16.69    $0.00
J9211   Idarubicin HCl                         5 mg      $375.73     $317.27    $0.00
        Injection, interferon Alfacon-
J9212   1, recombinant                        1 mcg        $3.67       $3.59    $0.00
        Injection, interferon alfa-2a,     3 million
J9213   recombinant                            units      $31.21      $30.84    $0.00
        Interferon alfa-2b,                1 million
J9214   recombinant                            units      $13.31      $13.12    $0.00
        Interferon alfa-N3, (human
J9215   leukocyte derived)               250,000 IU        $7.03       $8.60    $0.00
                                           3 million
J9216   Interferon gamma-1B                    units     $187.19     $292.24    $0.00
        Leuprolide acetate (for depot
J9217   suspension)                          7.5 mg       $500.58     $253.13   $0.00
J9218   Leuprolide acetate                     1 mg        $23.26      $13.49   $0.00
J9219   Leuprolide acetate implant            65 mg     $4,831.40   $2,206.27   $0.00
        Mechlorethamine HCl,
J9230   (nitrogen mustard)                    10 mg       $10.74      $10.45    $0.00
J9245   Injection, melphalan HCl              50 mg      $375.88     $388.73    $0.00
J9250   Methotrexate sodium                    5 mg        $0.35       $0.20    $0.00
J9260   Methotrexate sodium                   50 mg        $4.25       $2.16    $0.00
J9263   Oxaliplatin                          0.5 mg        $8.45       $8.24    $0.00
J9265   Paclitaxel                            30 mg      $138.28      $15.85    $0.00
                                         single dose
J9266   Pegaspargase                             vial   $1,277.13   $1,459.51   $0.00
J9268   Pentostatin                           10 mg     $1,644.27   $1,870.88   $0.00
J9270   Plicamycin                           2.5 mg        $83.93      $78.99   $0.00
J9280   Mitomycin                              5 mg        $57.12      $23.38   $0.00
J9290   Mitomycin                             20 mg       $185.64      $65.91   $0.00
J9291   Mitomycin                           40 mg              $255.00     $141.14       $0.00
J9293   Injection, mitoxantrone HCl           5 mg             $321.52     $321.80       $0.00
J9300   Gemtuzumab ozogamicin                 5 mg           $1,953.94   $2,203.67       $0.00
J9310   Rituximab                          100 mg              $438.38     $442.01       $0.00
J9320   Streptozocin                            1g             $126.58     $153.82       $0.00
J9340   Thiotepa                            15 mg               $83.73      $43.57       $0.00
J9350   Topotecan                             4 mg             $706.17     $739.69       $0.00
J9355   Trastuzumab                         10 mg               $52.01      $52.99       $0.00
J9357   Valrubicin, intravesical           200 mg              $471.24     $369.60       $0.00
J9360   Vinblastine sulfate                   1 mg               $2.81       $0.96       $0.00
J9370   Vincristine sulfate                   1 mg              $30.40       $3.50       $0.00
J9375   Vincristine sulfate                   2 mg              $60.81       $7.00       $0.00
J9380   Vincristine sulfate                   5 mg             $152.02      $17.50       $0.00
J9390   Vinorelbine tartrate                10 mg               $76.19      $69.09       $0.00
J9395   Injection, Fulvestrant              25 mg               $81.57      $80.51       $0.00
J9600   Porfimer sodium                     75 mg            $2,329.60   $2,285.15       $0.00
        Injection, epoetin alpha, (for
Q0136   non ESRD use)                    1000 units             $11.62     $10.18        $0.00
        IM injection, interferon beta 1-
Q3025   a                                  11 mcg               $80.22     $85.18        $0.00

        TOTALS                                                                       0   $0.00


        MEDICARE IMPACT CALCULATIONS:
        Estimated total Medicare revenue for Q1 2005             $0.00
        Estimated total Medicare cost for Q1 2005                $0.00
        Total Medicare profit or loss for Q1 2005                $0.00
        Projected net margin on Medicare drugs in Q1 2005   #DIV/0!
ES

to analyze the detailed
 s. Please be assured




                  J       K   L   M   N
                               Total         Profit or
                            allowable      loss for Q4
Total cost for                                            Variance
                             Q4 2004           2004
   Q1 2005     Total profit                             between Q4
                            (assuming       (assuming
(assuming Q3 or loss for Q1                             2004 and Q1
                                Q3              Q3
     2004         2005                                  2005 profits
                            utilization     utilization
 utilization)                                            and losses
                              for all         for all
                             payers)         payers)




        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00
        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00
        $0.00         $0.00        $0.00         $0.00        $0.00
        $0.00         $0.00        $0.00         $0.00        $0.00

        $0.00         $0.00        $0.00         $0.00        $0.00
        $0.00         $0.00        $0.00         $0.00        $0.00
        $0.00         $0.00        $0.00         $0.00        $0.00
        $0.00         $0.00        $0.00         $0.00        $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00


$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00
$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

$0.00   $0.00   $0.00   $0.00   $0.00

								
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