CMS releases list of Part B drugs with reduced coinsurance

Wednesday, June 21, 2023

CMS recently released a list of the 43 Part B drugs and biologicals that will be included in the Medicare Prescription Drug Inflation Rebate Program for July 1–September 30. The companies that manufacture these drugs will be required to pay rebates to Medicare when their prices increase faster than the rate of inflation.

“The Medicare Prescription Drug Inflation Rebate Program is a critical way to address long-term price increases by drug companies, and CMS is continuing our work to make prescription drugs more affordable for people with Medicare,” said Chiquita Brooks-LaSure, administrator of CMS, in a press release.

For the 43 drugs and biologicals on the list, the beneficiary coinsurance will be 20% of the inflation-adjusted payment amount, according to CMS. Between July 1–September 30, Medicare beneficiaries who use these drugs may pay lower coinsurance amounts, according to CMS.

CMS noted that it posts payment information each quarter for separately payable Part B drugs in the Medicare Part B average sales price (ASP) files on its website. The Part B rebatable drugs that are subject to coinsurance adjustments are also posted by CMS.

The agency typically releases the ASP public files several weeks before they go into effect to give the public time to review them for potential discrepancies. Posted quarterly files may be subject to updates before or after the beginning of the quarter.

Revenue integrity professionals should ensure patients are billed for the correct amount of coinsurance for the affected drugs and should review systems and provide education where necessary.