Submitting OIG:
Report Description:
When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive payment amounts. The Social Security 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 only make this substitution only if the ASP for a drug exceeds the AMP by 5 percent in the 2 previous quarters or 3 of the previous 4 quarters.
Date Issued:
Monday, August 6, 2018
Agency Reviewed / Investigated:
Submitting OIG-Specific Report Number:
OEI-03-18-00120
Component, if applicable:
Centers for Medicare & Medicaid Services
Location(s):
Agency-Wide
Type of Report:
Inspection / Evaluation
Number of Recommendations:
1
View Document:
Attachment | Size |
---|---|
oei-03-18-00120.pdf | 1.35 MB |
Additional Details Link: