OIG tells CMS again: Switch to ASP for infusion drugs

Thursday, September 8, 2016

WASHINGTON – The Office of Inspector General in a new report reiterates its concerns that, unlike most Part B drugs, Medicare payment amounts for DME infusion drugs are still based on average wholesale prices from 2003. Three years ago, the OIG published a report recommending changes to Medicare payments for DME infusion drugs; however, CMS has continued to reimburse for these drugs at prices that are unrelated to the amounts providers pay to acquire them. The OIG is concerned that paying for the drugs based on flawed AWPs may create access issues or lead to excessive billing. For example, payments that are below costs could make providers less willing to provide a drug, while payments that substantially exceed costs could make them over-utilize a drug. The OIG again recommends that CMS seek a legislative change that would require payments for DME infusion drugs to be based on average sales prices (ASPs), or use its existing authority to include DME infusion drugs in its competitive bidding program.