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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)
Completed Centers for Medicare and Medicaid Services Congressional Mandate: Noncovered Versions of Part B Drugs Office of Evaluation and Inspections OEI-BL-22-00380 2024