OIG Report on Medicare Part B Drug Pricing
The OIG has issued a report comparing Part B drug average sales prices (ASPs) and average manufacturer prices (AMPs) for 2007. By way of background, under section 1847A(d)(3) of the Social Security Act, the OIG must notify the HHS Secretary if the ASP for a particular drug exceeds the drug's AMP by a threshold of 5%. If that threshold is met, the Secretary is authorized to disregard the ASP for that drug and substitute the lesser of the widely available market price for the drug or 103 percent of the AMP. To date, OIG has issued seven quarterly reports comparing ASPs to AMPs, but CMS has not yet adjusted reimbursement as a result of OIG's findings. In the new report, the OIG identified 71 Medicare Part B drug codes that would have been eligible for price adjustment if a revised payment methodology recently implemented by CMS had been in effect throughout 2007 (other codes may also have been eligible but AMP amounts were not available). The OIG recommends that CMS develop a process to adjust payment amounts based on the results of OIG's pricing comparisons, lower Medicare reimbursement amounts for drugs that meet the 5-percent threshold, and ensure that drug manufacturers are submitting the required AMP data in a timely manner. CMS generally agreed to develop a process for adjusting payment amounts, but did not specifically agree to lower Medicare reimbursement for drugs that meet the 5-percent threshold.
