DRUG REIMBURSEMENT: CMS Invites Least Costly Alternative for Drugs

Article Overview

This article covers a CMS program memo addressing Medicare drug reimbursement changes, including retroactive payment corrections, the Single Drug Pricer, and how pricing interacts with coverage policy. It is relevant to billing professionals, physician practices, and reimbursement staff who need to track CMS payment updates, national pricing consistency, and related claim adjustment guidance. The article also discusses broader CMS positions on pricing methodologies and clarification for certain claim categories.