Tag: Average Sales Price (ASP)

WASHINGTON – Medicare and its enrollees have saved $73.4 million since 2013, because of CMS’s price substitution policy for Part B covered drugs, according to an August issue brief from the Office of Inspector General. They could have realized an additional $889,000 in savings in 2021, if CMS expanded the price-substitution criteria, the OIG says. When Congress established average sales prices (ASPs) as the basis for reimbursement for Medicare Part B drugs, it also provided a mechanism...

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...

WASHINGTON – Eight drug codes met CMS’s price substitution criteria in the first quarter of 2022 by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to a new Office of Inspector General report. The OIG is providing the eight drug codes to CMS for its review. The OIG says CMS should review the information to pursue price substitutions that would limit excessive payments for Part B drugs. To conduct the study, the OIG obtained average...

WASHINGTON – Eight codes for Part B drugs in the third quarter of 2021 met CMS’s price substitution criteria by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to an update from the Office of Inspector General. If the OIG finds that the average sales price for a drug exceeded the average manufacturer price by a certain percentage – currently 5% – the Social Security Act directs the secretary of Health and Human...

WASHINGTON – Seven 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 an update from the Office of Inspector General. If the OIG finds that the average sales price for a drug exceeded the average manufacturer price by a certain percentage – currently 5% – the Social Security Act directs the secretary of Health and Human Services to substitute the ASP-based payment...

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...

WASHINGTON - HME stakeholders have added two co-sponsors to a bill in the Senate that would delay a second round of Medicare reimbursement cuts slated for July 1.Sens. Debbie Stabenow, D-Mich., and James Lankford, R-Okla., signed on to S. 2736 on April 6. They join 15 other senators, a mix of Democrats and Republicans.The bill, introduced by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., on March 17, would delay the cuts slated for non-competitive bidding areas from July 1, 2016, to Oct. 1,...

BALTIMORE - Second quarter payments for respiratory drugs are up in most cases, with the exception of Budesonide (J7626), which decreased sharply, down nearly 73 cents per dose. Perforomist (J7606) saw the biggest increase, up 41 cents to $9.82 per dose, according to the latest average sales price (ASP) figures. Brovana (J7605) increased 24 cents to $8.50 per dose. Albuterol (J7613) and ipratropium (J7644) stayed fairly flat, at 12.5 cents per dose and 10.5 cents per dose, respectively.

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 - The House of Representatives on June 17 passed a bill that included a provision that would switch payment for Part B home infusion drugs to an average sales price model—a model that is unsustainable, say infusion stakeholders.“The services that are associated with Part B infusion drugs are not reflected in the policy lawmakers are moving forward,” said Kendall van Pool, vice president of legislative affairs for the National Home Infusion Association. “If this...