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|