OIG to CMS: Review eight codes
By HME News Staff
Updated 10:37 AM CDT, Tue August 30, 2022
WASHINGTON – Eight drug codes met CMS’s price substitution criteria in the first quarter of 2022 by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to a new Office of Inspector General report. The OIG is providing the eight drug codes to CMS for its review. The OIG says CMS should review the information to pursue price substitutions that would limit excessive payments for Part B drugs. To conduct the study, the OIG obtained average sales price (ASP) and average manufacturer price (AMP) data for Part B drugs for the first quarter 2022 from CMS. It then compared the volume-weighted ASPs and AMPs and identified all drugs with complete data for which the ASPs exceeded the AMPs by at least 5%. The Social Security Act mandates that the OIG compare ASPs with AMPs to monitor market prices and limit potentially excessive payment amounts.
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