Congressional Mandate: Noncovered Versions of Part B Drugs
Under the Consolidated Appropriations Act, 2021, Congress enacted provisions requiring CMS to remove noncovered, self-administered versions of Cimzia and Orencia from Part B payment amount calculations beginning in July 2021. Through the same legislation, Congress required OIG to conduct periodic studies to identify additional instances in which including noncovered versions of a drug were increasing Part B reimbursement amounts. In response, OIG will conduct a study every 6 months to: (1) identify any Part B drugs that have a payment amount based in part on noncovered, self-administered versions of the drug; and (2) determine whether payment amounts would have decreased or increased if noncovered, self-administered versions had been removed from payment amount calculations.
Announced or Revised | Agency | Title | Component | Report Number(s) | Expected Issue Date (FY) |
---|---|---|---|---|---|
July 2022 | Centers for Medicare and Medicaid Services | Congressional Mandate: Noncovered Versions of Part B Drugs | Office of Evaluation and Inspections | OEI-BL-22-00380 | 2023 |