Comparisons of Average Sales Prices to Widely Available Market Prices for the Fourth Quarter 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 differed from the drug's average manufacturer price or widely available market price (WAMP) by at least 5 percent, the Secretary of Health and Human Services 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)
February 2024	Centers for Medicare and Medicaid Services	Comparisons of Average Sales Prices to Widely Available Market Prices for the Fourth Quarter 2023	Office of Evaluation and Inspections	OEI-03-24-00110	2024