CMS Reports Decrease in Part B Drug Prices

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  • February 3, 2017
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CMS Reports Decrease in Part B Drug Prices

The Centers for Medicare & Medicaid Services (CMS) has released the files containing the payment amounts for Part B covered drugs for the first quarter of 2017. Medicare Part B payment limits for valid HCPCS codes that are not included in the quarterly pricing files will be determined by local Medicare contractors.
Comparing the first quarter 2017 payment amount with the prior quarter reveals that, on average, prices for Part B drugs decreased by 0.4 percent. For most of the higher volume drugs (29 out of the top 50), the prices changed 2 percent or less. Overall, the prices for 20 of the top 50 drugs decreased, while one remained the same. In general, among the top drugs with a decrease, there are a number of competitive market factors at work – multiple manufacturers, alternative therapies, new products, recent generic entrants, or market shifts to lower priced products.
Where applicable, the payment amounts are 106 percent of the Average Sales Price (ASP), calculated from data submitted by drug manufacturers. The quarter-to-quarter price changes are generally the result of updated data from the manufacturers of these drugs.
CMS guidance requires physicians and other providers to bill using the appropriate HCPCS Level II or CPT® code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy.
Effective Jan. 1, 2017, payment for infusion drugs furnished through a covered item of durable medical equipment (DME) will be based on the ASP of these drugs.
The ASP Drug Pricing Files for 2017 and subsequent years will no longer contain columns for the Infusion Average Wholesale Prices or the DME infusion limit. Unless otherwise specified, the Payment Limit in column D will be applied to payments for drugs infused through covered DME. Additional information of DME Infusion Drug Pricing is available through the DME MACs.

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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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