In 2005, Congress mandated that OIG monitor Part B drug average sales prices that exceed average manufacturer prices by at least 5 percent. After looking at the most recent quarter, the OIG found that while CMS may have over-reimbursed for some drugs, a price substitution policy could mitigate future “waste.” The proposed price substitution policy would lower the reimbursement amounts for drugs that exceed the 5 percent threshold.
“Although we acknowledge that the savings from any single OIG report may be modest relative to total expenditures for Part B drugs, significant savings would have accrued had CMS taken action immediately after OIG issued its first pricing comparison,” according to the report. “In the long term, savings achieved through price substitution could reduce waste and conserve taxpayer funds at a time when increased focus has been placed on rising healthcare costs and fiscal responsibility.”
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