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WAMP-Based Part B Reimbursement For Five Drugs Could Save $67 Mil. – OIG

Executive Summary

The HHS Office of Inspector General (OIG) contends that reimbursement for five Medicare Part B drugs is too high relative to their market prices and recommends that CMS lower payment levels for them

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OIG Report Highlights Difficulty In Measuring “Widely Available Market Price” For Drugs

Limitations and irregularities in sales data prevent an accurate comparison of average sales price and widely available market price for Medicare Part B drugs, a differential that can be the basis for modifying reimbursement.

Medicare Part B drug prices

HHS Office of Inspector General identifies 34 Healthcare Common Procedure Coding System drug codes with first quarter 2007 average sales prices that exceeded average manufacturer prices by at least 5 percent, thus qualifying the drug products for price adjustments under Medicare Part B in a Sept. 18 report to CMS. Lowering reimbursement amount for the 34 products to 103 percent of the AMPs would reduce Medicare allowances by an estimated $9 million in third quarter, report estimates. The Medicare Modernization Act tasked OIG with comparing ASPs to AMPs for physician-administered drugs covered by Medicare Part B; report is third released so far by OIG (1"The Pink Sheet" July 17, 2006, p. 17)...

Medicare Part B drug prices

HHS Office of Inspector General identifies 34 Healthcare Common Procedure Coding System drug codes with first quarter 2007 average sales prices that exceeded average manufacturer prices by at least 5 percent, thus qualifying the drug products for price adjustments under Medicare Part B in a Sept. 18 report to CMS. Lowering reimbursement amount for the 34 products to 103 percent of the AMPs would reduce Medicare allowances by an estimated $9 million in third quarter, report estimates. The Medicare Modernization Act tasked OIG with comparing ASPs to AMPs for physician-administered drugs covered by Medicare Part B; report is third released so far by OIG (1"The Pink Sheet" July 17, 2006, p. 17)...

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