Including Non-Covered Versions When Setting Payment Amounts for Part B Drugs
With certain exceptions, self-administered drugs are typically not covered under Medicare Part B. However, preliminary analysis shows that Part B payment amounts for a small number of drugs are being based, in part, on the average sales prices of non-covered, self-administered versions. We will examine how the Centers for Medicare & Medicaid Services determines which versions of drugs are included in Part B payment amount calculations, and the cost to Medicare and its beneficiaries of including non-covered, self-administered versions when calculating Part B payment amounts.
Announced or Revised | Agency | Title | Component | Report Number(s) | Expected Issue Date (FY) |
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Completed | Centers for Medicare & Medicaid Services | Including Non-Covered Versions When Setting Payment Amounts for Part B Drugs | Office of Evaluation and Inspections | OEI-12-17-00260 | 2018 |