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Comparison of Fourth-Quarter 2011 Average Sales Prices and Average Manufacturer Prices: Impact on Medicare Reimbursement for Second Quarter 2012


This review was conducted in accordance with the statutory mandate for the Office of Inspector General (OIG) to identify Medicare Part B prescription drugs with average sales prices (ASP) that exceed average manufacturer prices (AMP) by at least 5 percent. This review estimated the financial impact of lowering reimbursement amounts for drugs that met the 5-percent threshold to 103 percent of the AMPs, and also examined the potential effect of a July 2012 proposed rule that, among other things, specifies the circumstances under which the Centers for Medicare & Medicaid Services (CMS) will make AMP-based price substitutions.