Drug Pricing Information

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
April 25th, 2016

Single Drug Pricer (SDP): Effective January 1, 2003, contractors pay drug claims on the basis of the prices shown on the SDP files, if present, SDP includes the HCPCS Drug pricing file. 

Part B Drug pricing is the payment amounts that will be used to pay for Part B covered drugs.   The payment amounts can be paid to the provider or directly to the Beneficiary depending on how the claim was filed. 

This is the maximum Medicare Part B will pay.  This is not Part D coverage.   (Part D is for Rx - Drug coverage for Beneficiaries). 

ASP Drug pricing:  Included the vast majority of drugs and biologicals not priced on a cost or prospective payment basis will be priced based on the average sales price (ASP) methodology.

 

 

 

ESRD drugs furnished by both independent and hospital - based ESRD facilities, as well as specified covered outpatient drugs, and drugs and biologicals with pass -through status under the Outpatient Prospective Payment System(OPPS), will be priced based on the ASP methodology.

References:

Drug Pricing Information. (2016, April 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/drug-pricing-information-31606.html

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