Third Quarter Drug Pricing Files Available
The July 2017 Average Sales Price (ASP) and Not Otherwise Classified (NOC) drug pricing files and crosswalks are now available on the Centers for Medicare & Medicaid Services’ 2017 ASP Drug Pricing Files webpage.
These files contain the payment amounts that will be used to pay for Part B covered drugs for the third quarter of 2017 (July 1 – Sept. 30). For proper claims payment, review and ensure units billed do not exceed the maximum number of units per day, reporting instructions for associated codes, and other local or national payer policy.
Codes Added for July
There are four HCPCS Level II codes newly added to the July 2017 ASP Pricing File:
J9039 Injection, blinatumomab, 1 microgram
Q4132 Grafix core, per square centimeter
Q4133 Grafix prime, per square centimeter
Q9989 Ustekinumab, for Intravenous Injection, 1 mg
Ustekinumab (Stelara) is use to treat Crohn’s disease.
There is one new entry on the July 2017 NOC Pricing File:
Olaratumab (Lartruvo), 10 mg
Olaratumab is used in treating patients with soft tissue sarcoma not amenable to curative treatment with radiotherapy or surgery and with a histologic subtype for which an anthracycline-containing regimen is appropriate.
2017 Payment for Infusion Drugs
Remember that, effective Jan. 1, 2017, payment for infusion drugs furnished through a covered durable medical equipment supplier is based on the ASP, and the payment limit amount in Column D applies.