Medicare Payments for Stelara
Since 2016, total Medicare Part B payments to physicians for Stelara-an expensive drug used to treat certain autoimmune diseases that is often self-injected by patients in their home-have increased substantially. Such a large increase in payments for a drug that would not typically be covered under Part B raises questions about what is driving the growth, including the possibility of improper billing. In this study, OIG will (1) determine whether versions of Stelara that are typically self-injected meet the criteria for Medicare Part B coverage, (2) identify factors that may be causing the substantial growth in payments, and (3) determine whether claims for Stelara show evidence of improper billing by physicians.
|Announced or Revised||Agency||Title||Component||Report Number(s)||Expected Issue Date (FY)|
|May 2020||Centers for Medicare & Medicaid Services||Medicare Payments for Stelara||Office of Evaluation and Inspections||OEI-BL-19-00500||2021|