CMS Announces 2nd Quarter ASP Information

On March 17, 2005, CMS announced ASP information for the 2nd quarter of 2005.

The files below contain the actual payment amounts that will be used to pay for Part B covered drugs for the first and second quarters of 2005. The payment amounts are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. The quarter to quarter price changes are the result of updated and, in some cases, corrected data from the manufacturers of these drugs. The pricing files now carry a three decimal place payment amount, so some differences between the first and second quarter payment amounts are due to rounding differences.

For most of the higher volume drugs (26 out of the top 40), the payment amounts changed 2 percent or less, and for 16 of these codes the change was less than 1 percent. The payment amounts for 8 of the top 40 drugs increased. Among the top drugs with a decrease, in general, there are multiple manufacturers, alternative therapies, new products, and recent generic entrants. Prices for chemotherapy and inhalation drugs remain within the price range identified by the General Accountability Office (GAO), which GAO concluded would lead to sufficient provider reimbursement.

The following items can be found at http://www.cms.hhs.gov/providers/drugs/asp.asp:

• April 2005 ASP Pricing File and ASP NOC Pricing File
• April 2005 ASP NDC-HCPCS Crosswalk

CMS also has provided an update of its ASP Frequently Asked Questions that practitioners may find helpful. Additional information is also available on the CMS Web site.

The Office of the Inspector General (OIG) of the Health and Human Services Department and the Medicare Advisory Commission (MedPAC) are studying the effect of the new reimbursement system on hematology/oncology. Those studies are ongoing and are scheduled to be reported to Congress later this year.

ASH also continues to monitor the impact of ASP implementation on hematology practices and is soliciting information from practitioners about any problems they are having with ASP. If you are experiencing reimbursement problems with specific drugs, please contact Mila Becker, ASH's Director of Government Relations and Practice, so that we can report these problems to the OIG and MedPAC.