Can't find prescription drugs at ASP? You have few options

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers concerns about the availability of Medicare Part B drugs at average sales price (ASP) levels and the response from CMS and physician organizations. It is relevant to physicians, practice managers, coders, and reimbursement staff who track drug pricing, Medicare payment policy, and access to infused and injectable drugs. The article summarizes the kinds of pricing complaints being reported, the organizations monitoring the issue, and the general Medicare administrative contacts suggested for addressing pricing problems.

Why This Topic Matters

Drug pricing availability can affect whether practices can obtain and bill for Part B drugs at Medicare-set rates. Understanding the issue helps readers follow reimbursement concerns and the involvement of CMS, specialty societies, and medical associations.

What You Will Learn

  • How ASP-related drug pricing concerns are being reported in Medicare Part B settings.
  • Which types of organizations are monitoring or responding to drug availability issues.
  • What broad categories of drugs and specialties are involved in the complaints.
  • How CMS is described as reviewing price availability concerns.

Who Should Read This

  • Physicians
  • Practice managers
  • Medical coders
  • Reimbursement specialists
  • Billing staff
  • Clinic administrators

Codes Discussed


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