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Comparisons of Average Sales Prices to Widely Available Market Prices for the Second Quarter of 2023

When Congress established average sales prices (ASPs) as the basis for Medicare Part B drug reimbursements, it also provided a mechanism for monitoring market prices for drugs covered under Part B and limiting potentially excessive Medicare payment amounts. Section 1847A(d)(1)-(3) of the Social Security Act requires OIG to monitor the market prices of drugs and biologicals and report its findings to CMS. If OIG finds through its monitoring of drug prices that the ASP for a drug differs from the drug's average manufacturer price or widely available market price (WAMP) by at least 5 percent, the Secretary may substitute the ASP-based reimbursement amount with the lower amount in the following quarter. This evaluation will determine how ASPs used to calculate Part B reimbursement amounts for single-source drugs compare to WAMPs. The results of this evaluation could lead to changes in Part B drug payment amounts and ultimately produce savings for Medicare and its enrollees.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed Centers for Medicare and Medicaid Services Comparisons of Average Sales Prices to Widely Available Market Prices for the Second Quarter of 2023 Office of Evaluation and Inspections OEI-03-23-00320 2023