OBJECTIVE
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.
TIMELINE
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February 17, 2025Announced
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TodayOffice of Evaluation and Inspections In-Progress
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Est FY2027Estimated Fiscal Year for Project Completion