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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)
October 2017 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

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