Submitting OIG:
Report Description:
When Congress established average sales price (ASP) as the basis for reimbursement for Medicare Part B drugs (generally, drugs that are injected or infused in physicians’ offices or hospital outpatient settings), it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security Act (the Act) mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by a certain percentage (currently 5 percent), the Act directs the Secretary of Health and Human Services to substitute the ASP-based payment amount with a lower calculated rate. Through regulation, CMS outlined that it would make this substitution only if the ASP for a drug exceeded the AMP by 5 percent in the two previous quarters or three of the previous four quarters.
Date Issued:
Wednesday, August 12, 2020
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
OEI-03-20-00060
Location(s):
Agency-Wide
Type of Report:
Inspection / Evaluation
View Document:
Attachment | Size |
---|---|
OEI-03-20-00060.pdf | 99.27 KB |
Additional Details Link: