OIG: CMS overpays for infusion drugs

Thursday, April 23, 2015

WASHINGTON – CMS could have saved $251 million over an 18-month period if it paid for DME infusion drugs using an average sales price methodology, according to a new report from the Office of Inspector General. While most Part B drugs are paid at 106% of the ASP, infusion drugs are paid at 95% of the average wholesale price. Between the second quarter of 2013 and the third quarter of 2014, at least 42% of infusion drugs were paid at amounts that were more than twice their estimated acquisition costs, the report says. The OIG recommends that CMS either seek a legislative change requiring infusion drugs to be paid using ASP, or include the drugs in the next round of competitive bidding. CMS partially concurred with the first recommendation and concurred with the second.