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Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2019

When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive Medicare payment amounts. The Social Security Act mandates that OIG compare ASPs with average manufacturer prices (AMPs). If OIG finds that the ASP for a drug exceeds the AMP by 5 percent in the two previous quarters or three of the previous four quarters, the Secretary of Health and Human Services may substitute the reimbursement amount with a lower calculated rate. This quarterly memo summarizes the results of OIGs comparison analysis based on ASP and AMP data reported for the fourth quarter of 2019. The memo specifically reports the number of drugs OIG identified that met the criteria for substitution of a lower reimbursement amount.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
November 2019 Centers for Medicare & Medicaid Services Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2019 Office of Evaluation and Inspections OEI-03-20-00050 2020