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)|
|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|