OBJECTIVE
When Congress established average sales price (ASP) as the basis for Medicare Part B drug reimbursement, it also provided a mechanism for monitoring market prices and limiting potentially excessive Medicare payment amounts. Section 1847A(d)(1)−(3) of the Social Security Act mandates that OIG compare ASPs with average manufacturer prices (AMPs) and widely available market prices, if any. If OIG finds that the ASP for a drug exceeded the AMP by 5 percent in the two previous quarters or three of the previous four quarters, the Secretary of Health and Human Services may substitute the reimbursement amount with a lower calculated rate. Over the past decade, OIG has produced annual reports aggregating the results of our mandated quarterly ASP-to-AMP comparisons. This annual report will quantify the savings to Medicare and its beneficiaries that result directly from CMS’s price substitution policy using 2024 ASPs. The report may also recommend ways that Medicare can achieve additional savings.
TIMELINE
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December 15, 2025Announced
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TodayOffice of Evaluation and Inspections In-Progress
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Est FY2027Estimated Fiscal Year for Project Completion