Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2023 Average Sales Prices

(Source – oig.hhs.gov)

Medicare Part B annually spends billions of dollars to cover a limited number of outpatient prescription drugs. To safeguard Medicare and its enrollees from excessive payment amounts, Congress established a mechanism for monitoring market prices, whereby OIG identifies and refers to CMS Part B drugs with prices that exceed a specific threshold every quarter. CMS then applies its price-substitution policy to lower payment amounts for these drugs. Continue reading here…

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