OIG to CMS: Accuracy of Part B drug payments is substantially hindered
By HME News Staff
Updated 1:14 PM CST, Tue January 3, 2023
WASHINGTON – CMS should bolster its oversight of manufacturer-submitted average sales price (ASP) data to ensure accurate Part B drug payments, according to a new report from the Office of Inspector General.
Due to invalid or missing ASP data, CMS could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016-20, the OIG found.
“CMS was unable to calculate an ASP-based payment amount for several reasons, including that (1) the manufacturer reported a negative sales or ASP value; or (2) the manufacturer had no sales to report for that quarter,” the agency stated. “The alternative payment methodology that CMS uses when ASP data are either unavailable or deemed invalid often results in higher drug payment amounts for Part B drugs.”
In total, the OIG found that 24% of drug codes were missing ASP data for one or more specific drugs within that code in at least one quarter between 2016-20.
The office also found that, when CMS reported late ASP data submissions from manufacturers it substantially hindered the agency’s ability to conduct effective oversight.
The OIG recommends that CMS build a strategy to strengthen its internal controls for ensuring the accuracy of Part B drug payments. CMS concurred with the recommendation.
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