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

WHY WE DID THIS STUDY

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.