CMS rule cuts reimbursement for new Part B drugs

Under a new rule, CMS will reimburse newly launched physician-administered drugs covered under Medicare Part B at the wholesale acquisition cost (WAC) plus 3%, down from WAC plus 6%, effective Jan. 1, 2019.

Under the current Part B buy-and-bill model, CMS reimburses doctors or hospitals for the average sales price (ASP) of injectable drugs plus 6% to cover storage and handling. Newly launched drugs, however, are reimbursed using the drug's WAC until an ASP can be calculated based on sales reports. Since a WAC does not include discounts, it typically exceeds a drug's ASP, CMS said...