OIG: Seven drug codes up for price substitutions
By HME News Staff
Updated 9:32 AM CST, Tue November 16, 2021
WASHINGTON – Seven drug codes 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 seven drug codes to CMS for its review. It says CMS should review this information to determine whether to pursue price substitutions that would limit excessive payments for Part B drugs.
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