OIG recommends CMS review Part B drug prices

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Thursday, May 16, 2019

WASHINGTON – The average sales price for 10 drug codes for the fourth quarter of 2018 exceeded the average manufacture price by 5% or more for two consecutive quarters, according to a new report from the Office of Inspector General. Another five drug codes exceeded the AMP by at least 5% during the quarter but did not meet other price substitution criteria. When the ASP exceeds the AMP by 5%, the Department of Health and Human Services substitutes the ASP-based amount with a lower calculated rate, either 103% of the AMP or the widely available market price, whichever is less. The OIG has provided the 10 drug codes to CMS for review to determine whether or not the agency should pursue price substitutions that would limit excessive payments for Part B drugs.