OIG: Eight drug codes up for price substitutions
By HME News Staff
Updated 10:15 AM CST, Tue February 22, 2022
WASHINGTON – Eight codes for Part B drugs in the third quarter of 2021 met CMS’s price substitution criteria by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to an update from the Office of Inspector General. If the OIG finds that the average sales price for a drug exceeded the average manufacturer price by a certain percentage – currently 5% – the Social Security Act directs the secretary of Health and Human Services to substitute the ASP-based payment amount with a lower calculated rate. The OIG is providing the eight drug codes to CMS for review. It says CMS should review the information to determine whether to pursue price substitutions that would limit excessive payments for Part B drugs. The OIG found seven drug codes met CMS’s price substitution criteria in the second quarter of 2021.
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