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CSRO Address Potential Changes to CMS ASP +6 Reimbursement

Posted: March 3, 2016

In February of this year, CMS released guidelines to contractors, describing changes that the agency plans to test with regard to the ASP reimbursement formula. The guidelines reveal that Medicare is developing methods to test the impact of changes to Part B drug payments in certain (as yet unknown) zip codes.

The implementation date mentioned in the document was July 5. While nothing is confirmed, the rumor is that the proposal is currently under review at the Office of Management and Budget, which is the last stop before regulatory proposals are publicly released.

It is important to remember that this is not a national payment change at this point, but rather a demonstration project that would be mandatory for certain zip codes. Even so, there are procedural concerns with CMS making such a change via regulation or demonstration, given that the Average Sales Price methodology was enacted by Congress in the Medicare Modernization Act of 2003.

CSRO has joined other patient and provider groups to send a letter to CMS expressing concerns and will also reach out to the congressional committees with oversight over the agency.