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What the OIG found about Medicare Part B drug payments - DHS-OIG
Medicare Part B pays for covered drugs and biologicals, including covered preventive vaccines, using several methodologies. The Average Sales Price (ASP) is the primary methodology used for Pricing Part B Drugs; however, in the absence of ASP data, CMS may use wholesale acquisition cost-based prices (WAC). Additionally, in certain circumstances CMS substitutes payment amounts with Office of the Inspector General-derived amounts based on the Widely Available Market Price (WAMP) or the Average Manufacturer’s Price (AMP). Medicare pays for preventive Part B vaccines at a rate of 95 percent of the average wholesale price (AWP).
In a recent report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) found the Centers for Medicare & Medicaid Services (CMS) application of its price-substitution policy to drugs identified and referred by OIG saved Medicare and its enrollees $76 million since 2013. To read the OIG report, click here…
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