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 studies to identify additional drugs for which noncovered self-administered versions are included in Part B payment amounts, and to determine whether they should be excluded from Part B payment amount calculations. In response, OIG will conduct periodic studies identifying drugs for which noncovered self-administered versions were included in Part B payment amounts. In general, for the drugs that OIG identifies, CMS is required to remove noncovered self-administered versions from payment amount calculations in subsequent quarters if the exclusions would result in lower payment amounts; however, the statute provides CMS with some discretion in addressing the requirement.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
Completed (partial)	Centers for Medicare and Medicaid Services	Congressional Mandate: Noncovered Versions of Part B Drugs	Office of Evaluation and Inspections	OEI-BL-22-00380; OEI-BL-24-00030	2024