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Series: Comparison of Average Sales Prices and Average Manufacturer Prices

Announced on  | Last Modified on  | Series Number: SRS-E-26-002
Status
Active
Agency
Centers for Medicare and Medicaid Services

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 (WAMPs) (if any). If OIG finds that the ASP for a drug exceeds 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. This quarterly memo summarizes the results of OIG's comparison analysis based on ASP and AMP data. The memo specifically reports the number of drugs OIG identified that met the criteria for substitution of a lower reimbursement amount.

There are 4 projects in this series.

ACTIVE PROJECTS IN THIS SERIES (3)

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2025

Project OEI-03-26-00040 • Announced on Oct 1, 2025

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2025

Project OEI-03-26-00050 • Announced on Oct 1, 2025

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2026

Project OEI-03-26-00060 • Announced on Oct 1, 2025

COMPLETED PROJECTS IN THIS SERIES (1)

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2025

Project OEI-03-26-00030 • Completed on November 13, 2025

TIMELINE

  • October 1, 2025
    Series Number SRS-E-26-002 Assigned
  • October 1, 2025
    Projects Announced

    Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2025 - OEI-03-26-00030

  • Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Third Quarter of 2025 - OEI-03-26-00040

  • Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Fourth Quarter of 2025 - OEI-03-26-00050

  • Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the First Quarter of 2026 - OEI-03-26-00060

  • November 13, 2025
    Project Complete - OEI-03-26-00030

    Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2025 has been marked as complete. Report Published

  • Today
    3 Evaluations In-Progress
  • Est FY2027
    Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

Comparison of Average Sales Prices and Average Manufacturer Prices: Results for the Second Quarter of 2025 (OEI-03-26-00030)

In the second quarter of 2025, 12 drug codes met CMS’s price-substitution criteria by exceeding the 5-percent threshold for 2 consecutive quarters or 3 of the previous 4 quarters.

No recommendations were issued as a part of this report.
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
OIG Statutory Authority and Regulatory Matters Prescription Drug
Target Groups
Elderly
Financial Groups
Medicare B