CMS Confirms Continued Separate Payment for Omeros’ Omidria in Ambulatory Surgery Centers

Omeros announced that the Centers for Medicare & Medicaid Services (CMS) confirmed separate payment in ambulatory surgery centers (ASCs) for Omeros’ cataract surgery drug Omidria (phenylephrine and ketorolac intraocular solution) 1%/0.3%. In its final rule directed to the Medicare outpatient prospective payment system (OPPS) and the ASC payment system for calendar year 2021, CMS confirmed that Omidria qualifies for separate payment under CMS’ policy for non-opioid pain management surgical drugs when used in the ASC setting. This separate payment for Omidria is effective retroactively beginning October 1, 2020.

“Omeros appreciates CMS’ decision to continue paying separately for our ophthalmic drug Omidria,” Gregory A. Demopulos, MD, Omeros’ chairman and chief executive officer, said in a company news release. “Having just come off its pass-through status, this is the first time that Omidria qualifies under CMS’ payment policy for non-opioid pain-management surgical drugs in the ASC setting. In addition to reducing patient exposure to opioids, CMS’ decision continues to provide important access to Omidria for Medicare beneficiaries and to allow ophthalmic surgeons to use their best medical judgment to treat those patients. This is a good outcome for surgical facilities, surgeons and their patients.”

Omidria is the first and only FDA-approved product for use during cataract or lens replacement surgery that prevents pupil constriction during surgery and reduces postoperative ocular pain. In post-marketing studies, Omidria has been shown to have a broad range of benefits, including the reduction of sight-threatening complications and mitigating the need for intra- and postoperative steroids. Omidria is approved for use in both adults and children.