Tag: Infusion drugs

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...

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,...