OIG provides latest pricing update on Part B drugs

Wednesday, November 18, 2020

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 second quarter ASP and AMP data for Part B drugs, and calculating the volume-weighted AMP for each drug, consistent with CMS’s methodology for calculating volume-weighted ASPs. It then compared the volume-weighted ASPs and AMPs, and identified all drugs with complete data for which the ASPs exceeded the AMPs by at least 5%. The OIG also identified drugs that met CMS’s duration criteria for price substitution, meaning they exceeded the threshold in the two previous quarters or three of the previous four quarters.