Free ophthalmology tool
Buy-and-bill margin calculator
Type your acquisition cost and your payment. It shows margin per injection, then what a percentage billing fee does if the fee sits on all collections versus collections after the drug is pulled out. No published ASP table. Your numbers only. Runs in your browser. No patient data.
Illustration only. Not billing, legal, tax or clinical advice. Check the current schedule. Do not enter patient information. This tool runs entirely in your browser; nothing is sent anywhere.
Methodology
- Margin per shot = payment per dose minus acquisition cost per dose.
- Monthly margin = margin per shot times injections per month. Annual = monthly times 12.
- Fee on all collections = payment per dose times injections per month times fee percent divided by 100.
- Fee excluding drug = (payment minus cost) times injections per month times fee percent divided by 100.
- Fee as share of drug spread = fee per shot divided by margin per shot, times 100.
Worked example (illustrative)
Aflibercept (Eylea). Cost $1,850 per dose. Payment $2,060 per dose. 30 injections per month. Fee 5%.
Margin per shot: $210. Monthly margin: $6,300. Annual: $75,600.
Fee on all collections: $2,060 times 30 times 5% = $3,090 per month. That is 49% of the drug spread.
Fee excluding drug: $210 times 30 times 5% = $315 per month. That is 5% of the drug spread.
Same fee percent. Different base. One eats half the spread; the other takes a sliver. That is why the base matters more than the percent on a retina book.
Sources
- CMS ASP Regulations and Policy, Medicare Part B drug payment methodology.
- CMS biosimilar payment: ASP plus 6% of reference product ASP; temporary ASP plus 8% for qualifying biosimilars.
- ASPE and CMS guidance on biosimilar reimbursement and the limited window for the higher add-on.