Federal Reports

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 (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 2 previous quarters or 3 of the previous 4 quarters.

We reviewed the oversight of opioid prescribing and the monitoring of opioid use in Nevada. This factsheet shows Nevada's responses to our questionnaire covering five categories related to its approach to addressing the opioid epidemic: policies and procedures, data analytics, programs, outreach, and other efforts. The information in this factsheet, along with information from seven additional States, will be summarized in a report to the Centers for Medicare & Medicaid Services.

The Guide provides a baseline framework and common methodology for the IG community to employ in determining if their respective agencies met the requirements of the DATA Act. The fiscal year 2019 Guide was updated for the second required report, due November 8, 2019.