Long Term Care & Senior Living Blog

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule to reduce Medicare expenditures by changing the way it makes payments for Part B drugs. The proposal includes two phases. The first involves changing the percent of add-on to the Average Sales Price (ASP) of the drugs from 6% to 2.5% plus a flat fee payment. The second phase would utilize the value-based purchasing tools now used by commercial health plans, pharmacy benefit managers, hospitals and other entities that manage health benefits and drug utilization. The purpose of these proposed changes is to make Medicare spending on drugs more efficient while ensuring quality care for Medicare beneficiaries.

Two recently announced settlements with Washington State and the Federal government show two potential overpayment issues for providers.