OIG: CMS could lower Medicare payment for 15 Part B drugs

In a report this week, the Department of Health and Human Services’ Office of Inspector General identified 15 drug codes that in third-quarter 2022 met the Centers for Medicare & Medicaid Services’ criteria for substituting a lower Medicare price for certain Part B drugs. This means CMS may substitute either the widely available market price or 103% of the Average Manufacturers Price, whichever is less, when pricing these drugs, rather than using Average Sales Price plus 6%. The report does not identify the 15 drug codes.