The Centers for Medicare & Medicaid Services (CMS) has published the fiscal year (FY) 2026 Hospital Inpatient Prospective Payment Systems (IPPS) final rule. It includes a 3.3 percent rate increase which is reduced by a 0.7 percent productivity adjustment resulting in a payment rate increase of 2.6 percent for hospitals over FY 2025. This is 0.2 percent higher than the 2.4 percent rate increase in the proposed rule published in April. Hospitals are not reimbursed separately for blood products. Each year, CMS must reassess the payment rate to reflect hospital reporting of the price of goods and services used to treat all Medicare patients (known as the market basket).
The agency also responded in the 2026 Hospital IPPS final rule to comments regarding an, “Octapharma USA, Inc. application [submitted] for new technology add-on payments for Fibryga® for FY 2026.” Responding to the 2026 hospital IPPS final rule, CMS stated that, “[w]e appreciate the additional information from the applicant and commenter with respect to whether Fibryga® is substantially similar to existing technologies. However, we disagree with the applicant and commenter that Fibryga® has a new mechanism of action compared to cryoprecipitate and Intercept® Fibrinogen Complex.”
Additionally, CMS explained that, “[regarding] whether a technology is assigned to the same or a different Medicare Severity Diagnosis Related Group (MS-DRG), we agree with the applicant’s assertion in its application that it is not expected that the use of Fibryga® will affect the MS-DRG assignment…In regard to the third criterion, whether a technology treats the same or similar type of disease and patient populations, we disagree that the use of Fibryga® and Intercept® Fibrinogen Complex involves different patient populations or disease types…As we stated previously and in the FY 2022 IPPS/LTCH PPS final rule (86 FR 45149), the 5-day shelf life post-thaw of Intercept® Fibrinogen Complex makes it immediately available in a ready-to-transfuse form as a fibrinogen source.” This clarification is part of the 2026 hospital rule considerations.
The agency concluded in the final rule discussion on Octapharma’s application for new technology add-on payments for Fibryga® that, “[b]ecause Fibryga® meets all three of the substantial similarity criteria, we believe Fibryga® is substantially similar to the Intercept® Fibrinogen Complex. Therefore, we consider the beginning of the newness period for Fibryga® to begin on the date the Intercept® Fibrinogen Complex became commercially available for the treatment and control of bleeding, including massive hemorrhage, associated with fibrinogen deficiency. Since Intercept® Fibrinogen Complex has been on the U.S. market since May 5th, 2021, the 3-year anniversary date of its entry onto the market occurred prior to FY 2026, and therefore, Fibryga® does not meet the newness criterion and is not eligible for new technology add-on payments for FY 2026.”
The final rule was published today, August 4th, in the Federal Register. Additional resources and information regarding the final rule are available on the CMS website. 2026 hospital IPPS final guidelines should be reviewed carefully. ABC will continue to provide updates on its advocacy efforts as they become available.