PHARMACEUTICALS: Medicare Slashes Drugs By Up To 60 Percent

Why This Topic Matters

Medicare drug payment changes can materially affect practice revenue, claims processing, and retroactive payment reconciliation. Readers need to know which drug payment codes were affected and that some adjustments were backdated, creating the possibility of prior under- or overpayment.

Article Sections

1. Payment updates and major decreases

   Overview of the CMS reimbursement update and the broad pattern of lower payment amounts affecting several drug products. The section emphasizes that the changes apply across a range of Part B drugs.

2. Retroactive decreases

   Discussion of selected drugs with payment reductions applied retroactively to earlier dates. The section notes that prior claims may have been affected by these adjustments.

3. Notable payment increases

   Summary of a smaller group of drugs that received higher reimbursement amounts instead of decreases. The section places those increases in the context of the overall payment update.