“Bona Fide Service Fees” Lawsuit Underscores Need For Care In Distributor Contracts, Medicaid AMP Calculations
Litigation being pursued by former drug wholesale association exec alleges that manufacturers inappropriately classed bona fide service fees as discounts, causing them to report inaccurate average manufacturer prices to CMS.
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Feds and the states aren’t getting large settlements (just over $55 mil. total) but the whistleblower case underscores how murky the definition of AMP remains; litigation against Genzyme is ongoing.
HHS Office of Inspector General says CMS’ price substitution policy for drugs exceeding 5% in ASP/AMP pricing differential would have saved Medicare $7 million in 2011, less than a tenth of a percent of total Part B drug spending, CMS does not concur with OIG recommendations to help increase savings.
Pharmaceutical industry stakeholders could have to wait another year before Medicaid details how to calculate average manufacturer prices for drugs and drug rebates and how to handle other complex issues from the Affordable Care Act.