decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2000 / AB-00-86
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Article Overview
This Medicare program memorandum explains a new source of average wholesale price data for drugs and biologicals and how it relates to quarterly payment updates. It is intended for Medicare intermediaries, carriers, and billing staff who need to understand the scope of the update, reporting expectations, and which product groups are included or deferred for further review. The article also provides extensive attachment tables listing affected products, NDCs, wholesalers, and pricing data.
Why This Topic Matters
The memorandum affects Medicare payment allowance calculations for drug and biological claims and may change how intermediaries and carriers handle price source updates for the referenced products. It is important for organizations responsible for Medicare drug pricing, claim processing, and quarterly updates.
Article Sections
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Change Request 1232
Introduces the program memorandum and its subject matter, including the broader Medicare pricing context and the purpose of the update.
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Attachment 1
Provides the main list of products and pricing data identified for use in the upcoming quarterly update, along with supporting wholesaler information.
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Attachment 2
Lists products set aside from immediate implementation and indicates that the usual pricing source should continue to be used while additional review occurs.
What You Will Learn
- The general purpose of an HCFA program memorandum about drug and biological pricing updates.
- How the memorandum frames the use of an alternate pricing data source for Medicare payment allowances.
- Which portions of the attached product lists are designated for immediate consideration versus deferred review.
- What kinds of operational reporting and claim-processing coordination are addressed in the memorandum.
Who Should Read This
- Medicare intermediaries
- Medicare carriers
- Hospital and clinic billing staff
- Pharmacy and drug pricing operations staff
- Health care reimbursement professionals
Codes Discussed
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