Medicare Drug Price Substitution For Part B Proposed Again By CMS
This article was originally published in The Pink Sheet Daily
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.
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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.
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.
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.