OIG Report on Medicare Part B Third Quarter Drug Payments
The HHS Office of Inspector General (OIG) has issued a report entitled "Comparison of Third-Quarter 2010 Average Sales Prices and Average Manufacturer Prices: Impact on Medicare Reimbursement for First Quarter 2011." In this latest report on drug payment policy, the OIG identified 24 HCPCS codes with average sales prices (ASP) that exceeded the average manufacturer prices (AMP) by at least 5% in the third quarter of 2010. Medicare spending associated with the 14 codes with complete AMP data would have been reduced by $10.3 million in the quarter if rates were based on 103% of AMP, as is authorized under the statute. As in previous reports, the OIG recommends that CMS develop a price substitution policy that reduces payment for drugs that meet the 5% threshold. The OIG also will continue to work with CMS to pursue appropriate actions against manufacturers that fail to submit required pricing data.
