Tag: Part B drugs

WASHINGTON – CMS should bolster its oversight of manufacturer-submitted average sales price (ASP) data to ensure accurate Part B drug payments, according to a new report from the Office of Inspector General.   Due to invalid or missing ASP data, CMS could not calculate an ASP-based payment amount for 8% of drug codes at least once between 2016-20, the OIG found.  “CMS was unable to calculate an ASP-based payment amount for several reasons, including that (1)...

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 - 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...

WASHINGTON - Suppliers may now dispense more than the 30-day supply for enteral nutrition and Part B drugs, according to an announcement for the DME MACs. The change is effective for claims with a date of service starting on March 1, 2020. This relief is related to CMS's National Emergency Authority. In future potential audits, contract reviewers will determine if the amount dispensed was reasonable and necessary by reviewing the patient's diagnosis, prospective interruptions and delays to the supply...

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 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...

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,...