CAP Physician Election Guide

The Medicare Part B Drug Competitive Acquisition Program (CAP) is an alternative to the Average Sales Price (ASP) method of acquiring many Part B drugs and biological administered incident to a physician’s services. CAP participation is open to Medicare physicians who administer drugs under the "incident to" provision in their offices.

Ordering CAP Drugs

Participating CAP Physicians must obtain all drugs on the CAP drug list from their chosen Approved CAP Vendor. If a Participating CAP Physician elects to obtain drugs through the CAP, the physician will complete an order form and fax it to the Approved CAP Vendor prior to the date of administration. Physicians must order drug on a patient- Specific basis. A Participating CAP Physician cannot use the CAP to supply a general stock of medication that would be used for a multiple number of patients except for emergency restocking as described below.

Emergency Restocking
For emergency situations, a Participating CAP Physician may administer drugs from the office inventory when all of the following conditions are met:
• The drugs are required immediately,

• The physician could not have anticipated the need for the drugs,

• The vendor could not have delivered the drugs in a timely manner, and

• The drugs were administered in an emergency situation.

If all of these conditions are met, drugs acquired through the CAP may replace the medication from the physician’s private inventory.