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.
Related News Articles
Headline
The Department of Health and Human Services and the Centers for Medicare & Medicaid Services Aug. 21 announced the creation of a Healthcare Advisory…
Headline
A JAMA study published Aug. 18 found that plan design changes by Medicare Part D insurers, particularly for Medicare Advantage plans, following passage of the…
Chairperson's File
The recently enacted One Big Beautiful Bill Act will bring big changes to health care. AHA President and CEO Rick Pollack joined me for a Leadership Dialogue…
Headline
The House Ways and Means Subcommittees on Health and Oversight held a joint hearing today to discuss lessons learned, challenges and opportunities to improve…
Headline
The AHA today expressed support for the Medicare Mental Health Inpatient Equity Act, a bill that would eliminate the 190-day lifetime limit on inpatient…
Headline
The AHA July 8 wrote in opposition to the “Patient Access to Higher Quality Health Care Act” (H.R. 4002), which would repeal current law banning the creation…