Congressional Mandate: Noncovered Versions of Part B Drugs in 2023-2024

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 studies to identify additional drugs for which noncovered self-administered versions are included in Part B payment amounts, and to determine whether they should be excluded from Part B payment amount calculations. In response, OIG will conduct periodic studies identifying drugs for which noncovered self-administered versions were included in Part B payment amounts. In general, for the drugs that OIG identifies, CMS is required to remove noncovered self-administered versions from payment amount calculations in subsequent quarters if the exclusions would result in lower payment amounts; however, the statute gives CMS some discretion in addressing the requirement.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
February 2025	Centers for Medicare & Medicaid Services	Congressional Mandate: Noncovered Versions of Part B Drugs in 2023-2024	Office of Evaluation and Inspections	OEI-BL-25-00110	2025