Amvuttra's clinic-based dosing puts reimbursement model in focus

Differences in how ATTR-CM drugs are given are drawing attention to the payment incentives around each treatment.

Alnylam's Amvuttra is injected every three months, and its prescribing information says it should be administered by a healthcare professional. That places it under Medicare Part B, which generally pays for such drugs at average sales price plus 6%, with a separate fee for administration.

Under this buy-and-bill model, practices buy the drug, give it and bill for both. Because the add-on is a percentage, it rises with a drug's price, a feature a Health Affairs brief said can work against cost control.

BridgeBio's Attruby and Pfizer's Vyndamax are oral drugs taken at home and dispensed through pharmacies, creating no comparable billing event for the prescriber. Attruby's label calls for tablets twice daily.

Commentary on buy-and-bill incentives argues that patients should be told when treatment options carry different revenue for the practice.