OIG: ASP continues to exceed AMP for certain drugs

Tuesday, March 10, 2020

WASHINGTON – The average sales price for 11 drug codes in the third quarter of 2019 met CMS’s price substitution criteria by exceeding the average manufacturer price by 5% for two consecutive quarters or three of the previous four quarters, according to a new report from the Office of Inspector General. When the ASP exceeds the AMP by 5%, the Department of Health and Human Services substitutes the ASP-based amount with a lower calculated rate, either 103% of the AMP or the widely available market price, whichever is less. The OIG recommends that CMS review the information to determine whether to pursue price substitutions that would limit excessive payments for Part B drugs.