Tag: ASP

WASHINGTON – Seven codes for Medicare Part B drugs met CMS’s price substitution criteria by exceeding the 5% threshold for wo consecutive quarters or three of the four previous quarters, according to a new report from the Office of Inspector General. To conduct the study, the OIG calculated the volume-weighted average manufacturer’s price for each drug, consistent with CMS's methodology for calculating volume-weighted average sales prices. The OIG is providing...

WASHINGTON - The average sales price for 11 drug codes in the third quarter of 2019 met CMS's price substitution criteria by exceeding the average manufacturer price by 5% for two consecutive quarters or three of the previous four quarters, according to a new report from the Office of Inspector General. When the ASP exceeds the AMP by 5%, the Department of Health and Human Services substitutes the ASP-based amount with a lower calculated rate, either 103% of the AMP or the widely available market...

WASHINGTON - The average sales price for 10 drug codes for the fourth quarter of 2018 exceeded the average manufacture price by 5% or more for two consecutive quarters, according to a new report from the Office of Inspector General. Another five drug codes exceeded the AMP by at least 5% during the quarter but did not meet other price substitution criteria. When the ASP exceeds the AMP by 5%, the Department of Health and Human Services substitutes the ASP-based amount with a lower calculated rate,...

ALEXANDRIA, Va. - A recent Office of Inspector General report on payment for Part B DME infusion drugs is far too narrow to be the basis for new policy, according to the National Home Infusion Association. The OIG's report recommends that CMS seek a legislative change that would require payments for DME infusion drugs to be based on average sales prices (ASPs), average wholesales prices from 2003. The NHIA argues, however, that Congress should “fix” the payment issue by passing the...

Senators want to review home infusion pricing with CMS WASHINGTON - More than a dozen senators have written a letter to Senate Majority Leader Mitch McConnell and Minority Leader Harry Reid asking for time to review S. 275, the Medicare Home Infusion Site of Care Act, with CMS. “We urge that the average sales price pricing provisions from H.R. 6 or H.R. 2570 not be included in any legislation that does not recognize the services component of care that is included in S. 275,” stated the...

BALTIMORE - Fourth-quarter payments showed healthy increases for several respiratory drugs. Brand name drugs Brovana (J7605) rose 88 cents to $8.08 per dose and Perforomist (J7606) rose 40 cents to $8.88 per dose. Budesonide (J7626) was up 19 cents to $5.39 per dose. Ipratropium (J7644) was unchanged at just under 11 cents per dose. Albuterol (J7613) was down nearly 2 cents to just under 12 cents per dose.

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,...

BALTIMORE - Pricing for budesonide took a plunge in the latest average sales price (ASP) figures for respiratory medications released in March.Budesonide (J7626) decreased 49 cents to $4.76 per dose for second quarter 2013. In the previous quarter, the drug saw an increase of 38 cents, to $5.26 per dose. Although a third generic version of budesonide has recently hit the market, it has had very limited distribution in the DME space and shouldn't have had much of an impact on pricing, says Wayne Vega,...

SAN DIEGO - ResMed has sued Taiwanese manufacturer Apex Medical and its U.S. distributor, Medical Depot, doing business as Drive Medical, to stop alleged patent infringement. ResMed has filed parallel legal actions in the International Trade Commission (ITC) and U.S. federal court, alleging its patents are being infringed by several Apex products, including the Wizard 210 and 220 masks; the Freedom 210 and 220 masks made by Apex and sold by Medical Depot; and the iCH and XT Fit flow generators. “We...