American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

DEA, FDA, and Medicare Part B Drugs

On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) released a proposal that tests a new payment model called the Part B Drug Payment Model, under authority of the Center for Medicare and Medicaid Innovation. Currently, Medicare Part B pays for select drugs that are administered in a physician’s office or the hospital outpatient department at Average Sales Price (ASP) plus a statutorily mandated 6 percent add-on. CMS proposes two phases for the Medicare Part B Drug Payment model. In phase one, CMS proposes to implement a variation of the add-on component of the Part B drug payment methodology, specifically ASP+2.5 percent plus a flat fee of $16.80. In phase two, CMS proposes to implement value-based purchasing tools in conjunction with phase one.

Medicare Part B Drug Payment Model Rule

ACS Comment Letter

Proposed Rule