tci Medicare Compliance & Reimbursement - 2006 Issue 19

PRESCRIPTION DRUGS: OIG To CMS--51 Drugs May Be Overpriced

CMS disputes OIGs calculations, however.A few dozen Part B drugs could be facing steep drops in their already-low reimbursements soon. The law gives the Centers for Medicare & Medicaid Services the authority to slash drug payments if the average sales price (ASP) is at least 5 percent higher than the average price the manufacturer actually charges. Medicare pays for Part B drugs based on ASP plus 6 percent. And the HHS Office of Inspector General's latest report says that 51 drugs had ASPs that were at least 5 percent higher than manufacturer prices, if you use CMS's...

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