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.
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Manufacturers’ submissions of average sales price data from drugs are entered manually by CMS staff; the HHS Inspector General recommends a fully automated process like the one used for average manufacturer price submissions.
BIO and PhRMA urge CMS to delay making reimbursement rate substitutions for Medicare Part B drugs based on comparing ASP to AMP until the agency finalizes its rules on the methodology for calculating AMP. The final AMP rule is expected in 2013.
The proposal to reimburse less for drugs that exceed a price substitution threshold, first made last year but never finalized, is part of the Physician Fee Schedule proposed rule for 2012.