Tag: Average Sales Price
OIG: Eight drug codes up for price substitutions
February 22, 2022HME News Staff
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...
OIG: Seven drug codes up for price substitutions
November 16, 2021HME News Staff
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...
OIG: Part B drugs exceed AMP threshold
February 18, 2021HME News Staff
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...
OIG provides latest pricing update on Part B drugs
November 18, 2020HME News Staff
WASHINGTON - Seven codes for Medicare Part B drugs 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 seven codes to CMS for its review. It says CMS should review this information to determine whether or not to pursue price substitutions that would limit excessive payments for Part B drugs. The OIG conducted its study by obtaining...
OIG recommends CMS review Part B drug prices
November 21, 2019HME News Staff
WASHINGTON - The average sales price for 11 drug codes for the second quarter of 2019 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 11 codes exceeded the 5% threshold in the second 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, either...
OIG recommends CMS review Part B drug prices
May 16, 2019HME News Staff
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,...
Deadline to sign infusion letter looms
January 19, 2017HME News Staff
WASHINGTON - The National Home Infusion Association seeks signatures for a letter that urges Congress to align the effective dates of switching to an average sales price reimbursement model for Part B infusion drugs.In the letter, addressed to Senate Majority Leader Mitch McConnell, Senate Minority Leader Charles Schumer, House Speaker Paul Ryan and Democratic Leader Nancy Pelosi, the association requests “quick action” to ensure beneficiaries have access to services, equipment and drugs.“The...
In brief: Two senators back bid bill, groups seek vent changes
April 8, 2016HME News Staff
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,...
ASP: Budesonide takes a dive
April 6, 2016HME News Staff
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.
NHIA pushes back on ASP
July 27, 2015Theresa Flaherty, Managing Editor
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...