The HHS Office of Inspector General (OIG) has issued a report entitled “End Stage Renal Disease Drugs: Facility Acquisition Costs and Future Medicare Payment Concerns.” Based on its review of a sample of ESRD drugs and facilities, the OIG concludes that aggregate acquisition costs for ESRD drugs at independent and hospital-based dialysis facilities were below Medicare reimbursement levels, with the acquisition costs for some separately-billable drugs decreasing over the last several years. As CMS moves to a bundled payment system for ESRD drugs, the OIG observes that if drug acquisition costs decrease while price indexes rise, “the existing gap between Medicare payment amounts and dialysis facility acquisition costs will continue to grow each year.” The OIG therefore recommends that CMS develop a more accurate method for estimating changes in the prices of ESRD drugs.