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Medicare Part B Drug Average Sales Price

Overview

Medicare Contractor Reporting Template for Medicare Part B Drugs - (Located in the "Downloads" section below)

As indicated in CR 4140, dated February 15, 2006, Medicare contractors shall use the Medicare Contractor Reporting Template for Part B drugs to report information on all Medicare Part B drugs not paid on a cost or prospective payment basis when payment limits are not listed in the quarterly drug pricing files, or in the OPPS Pricer. Contractors shall also use the template to report pricing information for the NOC drug billing codes. This information must be sent to CMS on a monthly basis to e-mail address: sec303aspdata@cms.hhs.gov.

New Information Regarding Medicare Payment and Coding for Drugs and Biologics (See Downloads section below for the message)

Section 303(c) of the Medicare Modernization Act of 2003 (MMA) revised the payment methodology for Part B covered drugs that are not paid on a cost or prospective payment basis. In particular, section 303(c) of the MMA amended Title XVIII of the Act by adding section 1847A, which established a new average sales price (ASP) drug payment system.  Beginning January 1, 2005, drugs and biologicals not paid on a cost or prospective payment basis will be paid based on the ASP methodology, and payment to the providers will be 106 percent of the ASP.  There are exceptions to this general rule which are listed in the latest ASP quarterly change request (CR) document.  The ASP methodology uses quarterly drug pricing data submitted to the CMS by drug manufacturers.  CMS will supply contractors with the ASP drug pricing files for Medicare Part B drugs on a quarterly basis.

 

Downloads
Medicare Contractor Reporting Template for Medicare Part B Drugs [ZIP, 5KB]

5/18/07 - Update to Information Regarding Medicare Payment and Coding for Drugs and Biologics [PDF, 21KB]

4/25/07 -Update to Information Regarding Medicare Payment and Coding for Drugs & Biologics [PDF, 22KB]

New Information Regarding Medicare Payment and Coding for Drugs and Biologics [PDF, 11KB]

ASP Data (Addendum A) - Updated 7/11/06 [Excel Zipped, 2KB]

ASP Certification form (Addendum B) [PDF 4KB]

List of drugs supplied under the CAP, corresponding NDCs, CAP Payment Amounts and Vendor VIN [PDF, 240KB]

Related Links Inside CMS

Details for RTC-Sales of Drugs and Biologicals to Large Volume Purchasers

Medicare Replacement Drug Demonstration

Competitive Acquisition for Part B Drugs & Biologicals

Frequently Asked Questions
Related Links Outside CMSExternal Linking Policy

There are no Related Links Outside CMS

 

Page Last Modified: 08/19/2008 8:24:30 AM
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