OIG to report eight drugs to CMS for review
By HME News Staff
Updated 12:24 PM CST, Wed February 15, 2023
WASHINGTON – Fifteen drug codes met CMS's price-substitution criteria by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to a new report from the Office of Inspector General. The OIG is providing the 15 drug codes to CMS for its review. The agency should review this information to determine whether to pursue price substitutions that would limit excessive payments for Part B drugs. The Social Security Act mandates that OIG compare ASPs with average manufacturer prices. If the OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5%), the Social Security Act directs the secretary of Health and Human Services to substitute the ASP-based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeded the AMP by 5% in the two previous quarters or three of the previous four quarters.
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