FDA-approved OMIDRIA delivers reimbursement without affecting your packaged payment

Following bipartisan leadership efforts in the Senate and House of Representatives, Congress enacted legislation that directed the Centers for Medicare & Medicaid Services (CMS) to grant an extension of pass-through reimbursement until October 1, 2020 to OMIDRIA and several other drugs. Pass-through status allows reimbursement for OMIDRIA separate from the packaged Ambulatory Payment Classification (APC) reimbursement for the cataract surgery procedure. CMS sets the payment rate at Average Sales Price (ASP)
plus 6%.

  • No copay in hospital outpatient departments (HOPDs)21
  • 20% copay in ambulatory surgery centers (ASCs)21
  • Approximately 90% of Medicare Part B patients have some form of supplemental insurance, which covers copays22
OMIDRIA is covered and paid by 100% of Medicare Administrative Contractors (MACs) across all 50 states and Puerto Rico

Based on currently available information and subject to change without notice. Individual plan coverage, policies, and procedures may vary and should be confirmed. Omeros does not guarantee coverage or payment.

No effect on physician fees21

Payment to the surgeon for cataract surgery under Medicare's Physician Fee Schedule will be unaffected by the use of OMIDRIA or the pass-through payments related to OMIDRIA, now and in the future.

No effect on the healthcare system21

The pass-through regulation is budget-neutral to the healthcare system. To the extent that ophthalmic surgeons/facilities elect not to access pass-through payments, the funds set aside will be used by other specialties. Any remaining amount will be lost to the system.

OMIDRIA has a unique billing code

C9447

Injection, phenylephrine and ketorolac, 4-mL vial

ASCs and HOPDs will use this unique HCPCS code to bill CMS and other payers for separate payment.*

*HOPDs=Hospital Outpatient Departments; HCPCS=Healthcare Common Procedure Coding System.

Learn More About OMIDRIAssure

 

Information contained herein is provided as a reference for obtaining appropriate and accurate reimbursement for the use of OMIDRIA in eligible patients. Omeros Corporation does not guarantee that the use of the recommended codes will result in reimbursement.

Indications and Usage

OMIDRIA® is added to ophthalmic irrigating solution used during cataract surgery or intraocular lens replacement and is indicated for maintaining pupil size by preventing intraoperative miosis and reducing postoperative ocular pain.

Important Safety Information

OMIDRIA must be added to irrigating solution prior to intraocular use.

OMIDRIA is contraindicated in patients with a known hypersensitivity to any of its ingredients.

Systemic exposure of phenylephrine may cause elevations in blood pressure.

Use OMIDRIA with caution in individuals who have previously exhibited sensitivities to acetylsalicylic acid, phenylacetic acid derivatives, and other nonsteroidal anti-inflammatory drugs (NSAIDs), or have a past medical history of asthma.

The most commonly reported adverse reactions at ≥ 2% are eye irritation, posterior capsule opacification, increased intraocular pressure, and anterior chamber inflammation.

Please see the Full Prescribing Information for OMIDRIA.

You are encouraged to report Suspected Adverse Reactions to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

OMEROS®, the OMEROS logo®, OMIDRIA®, the OMIDRIA logo®, and OMIDRIAssure® are registered trademarks of Omeros Corporation.
© Omeros Corporation 2018, all rights reserved. 2018-061

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References
  1. Omeros survey data on file.
  2. Rosenberg ED, Nattis AS, Alevi D, et al. Visual outcomes, efficacy, and surgical complications associated with intracameral phenylephrine 1.0%/ketorolac 0.3% administered during cataract surgery. Clin Ophthalmol. 2018;12:21-28.
  3. OMIDRIA [package insert]. Seattle, WA: Omeros Corporation; 2017.
  4. Lindstrom RL, Loden JC, Walters TR, et al. Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification. Clin Ophthalmol. 2014;8:1735-1744.
  5. Hovanesian JA, Sheppard JD, Trattler WB, et al. Intracameral phenylephrine and ketorolac during cataract surgery to maintain intraoperative mydriasis and reduce postoperative ocular pain: integrated results from 2 pivotal phase 3 studies [published correction appears in J Cataract Refract Surg. 2016;42:349] J Cataract Refract Surg. 2015;41:2060-2068.
  6. Donnenfeld ED, Whitaker JS, Jackson MA, Wittpenn J. Intracameral ketorolac and phenylephrine effect on intraoperative pupil diameter and postoperative pain in cataract surgery. J Cataract Refract Surg. 2017;43:597-605.
  7. Al-Hashimi S, Donaldson K, Davidson R, et al. Medical and surgical management of the small pupil during cataract surgery. J Cataract Refract Surg. 2018;44:1032-1041.
  8. Roach L. Strategies for preventing intraoperative miosis. EyeNet. June 2015:29-31.
  9. Chang DF, Campbell JR, Colin J, Schweitzer C; Study Surgeon Group. Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin. Ophthalmology. 2014;121:829-834.
  10. Ackman A, Yilmaz G, Oto S, Akova YA. Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation. Ophthalmology. 2004;111:1693-1698.
  11. Katsev DA, Katsev CC, Pinnow J, Lockhart CM. Intracameral ketorolac concentration at the beginning and end of cataract surgery following preoperative topical ketorolac administration. Clin Ophthalmol. 2017;11:1897-1901.
  12. Porela-Tiihonen S, Kaarniranta K, Kokki M. Postoperative pain after cataract surgery. J Cataract Refract Surg. 2013;39:789-798.
  13. Omeros data on file.
  14. Silverstein SM, Rana V, Stephens R, Segars L, Pankratz J, Shivani R, et al. Effect of phenylephrine 1.0%-ketorolac 0.3% injection on tamsulosin-associated intraoperative floppy-iris syndrome. J Cataract Refract Surg. 2018;44(9):1103-1108.
  15. Visco D. Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis. Clin Ophthalmol. 2018;12:301-305.
  16. Bucci FA Jr, Michalek B, Fluet AT. Comparison of the frequency of use of a pupil expansion device with and without an intracameral phenylephrine and ketorolac injection 1%/0.3% at the time of routine cataract surgery. Clin Ophthalmol. 2017;11:1039-1043.
  17. Walter K, Delwadia N. Miosis prevention in femtosecond cataract surgery using a continuous infusion of phenylephrine and ketorolac. Presented at: 2018 American Society of Cataract and Refractive Surgery (ASCRS) and American Society of Ophthalmic Administrators (ASOA) Annual Meeting; April 13-17, 2018; Washington, DC.
  18. Matossian C. Clinical outcomes of phenylephrine/ketorolac vs. epinephrine in cataract surgery in a real-world setting. Presented at: American Society of Cataract and Refractive Surgery (ASCRS) and American Society of Ophthalmic Administrators (ASOA) Annual Meeting; April 13-17, 2018; Washington, DC.
  19. Gayton JL. E-poster presented at: 15th International Congress on Vision Science and Eye; 2017 Aug 10-11; London, UK.
  20. Waterbury LD. Alternative drug delivery for patients undergoing cataract surgery as demonstrated in a canine model. J Ocul Pharmacol Ther. 2018;34:154-160.
  21. Medicare program: Proposed changes to hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs; requests for information on promoting interoperability and electronic health care information, price transparency, and leveraging authority for the competitive acquisition program for part B drugs and biologicals for a potential CMS innovation center model. Fed Regist. 2018;37046-37240.
  22. Kaiser Family Foundation analysis of the CMS Medicare Current Beneficiary Survey Cost and Use File, 2010.
  23. Guzek JP, Holm M, et al. Cotter JB, Cameron JA, Rademaker WJ, et al. Risk factors for intraoperative complications in 1000 extracapsular cataract cases. Ophthalmology. 1987;94(5):461-466.