OIG ASP/AMP Report for First Quarter 2010
The OIG has issued a report comparing first quarter 2010 Medicare ASPs and AMPs. The OIG identified 38 HCPCS codes with ASPs that exceeded AMP by at least 5% in the first quarter of 2010. Of these 38 HCPCS codes, 13 had complete AMP data (i.e., AMP data for every drug product that CMS used to establish reimbursement amounts). If reimbursement amounts for all 13 codes with complete AMP data had been based on 103% of the AMPs during that quarter (as is authorized by the statute), Medicare payments would have been reduced by almost $1 million. The OIG could not compare ASPs and AMPs for an additional 68 HCPCS codes because AMP data were not submitted for any of the national drug codes that CMS used to calculate reimbursement, even though manufacturers for 23% of those drug products had Medicaid drug rebate agreements under which they generally were required to submit AMPs. The OIG states that it will continue to work with CMS to pursue appropriate actions against manufacturers that fail to submit required pricing data.
