CMS Hospital Outpatient Prospective Payment Proposed Rule CY 2019 (OPPS).
This proposed rule further expands cuts to the 340B Drug Pricing program made in 2018 and institutes a site-neutrality payment policy for hospital outpatient departments by cutting reimbursement by 40% for the most commonly reimbursed G-codes in order to match payment under the Physician Fee Schedule, says Jillanne Schulte Wall, JD, director of federal regulatory affairs at the ASHP. The proposed rule also includes a request for information related to a potential Competitive Acquisition Program for Part B drugs and biologics, which would run through the Center for Medicare and Medicaid Innovation.
“The change to the federal 340B program reflects CMS’ continued insistence that the 340B program contributes to high drug prices, while the site-neutrality provision reflects CMS’ efforts to reduce Medicare expenditures,” Schulte Wall says.
Pharmacists should be aware that 2017’s cuts to reimbursement for drugs purchased under the 340B program for use in hospitals are being extended to hospital outpatient departments.
Therefore, drugs purchased for the 340B program for use in hospital outpatient departments will now be reimbursed at the average sales price (ASP) minus 22.5%, rather than ASP plus 6%, she says. Final OPPS rules generally take effect on January 1.
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