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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)
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