2019 ASP Drug Pricing Files
ASP Drug Pricing Files October 2019 Update
The files below contain the payment amounts that will be used to pay for Part B covered drugs for the fourth quarter of 2019. The October 2019 ASP payment limits have been updated.
Comparing the fourth quarter 2019 payment amounts with the prior quarter reveals that, on average, payment amounts for the top 50 Part B drugs decreased by 0.4 percent.
For most of the higher volume drugs (36 out of the top 50), the prices changed 2 percent or less. Overall, the prices for 28 of the top 50 drugs decreased, while three remained the same. In general, among the top drugs with a decrease, there are a number of competitive market factors at work – multiple manufacturers, alternative therapies or market shifts to lower priced products.
CMS remains interested in ensuring continued beneficiary access to Part B covered drugs. We will continue to monitor trends in pricing, as reflected by the published ASP payment rates, as well as utilization within the Medicare community.
Where applicable, the payment amounts in the quarterly ASP files are 106 percent of the Average Sales Price (ASP) calculated from data submitted by drug manufacturers. The quarter to quarter price changes are generally the result of updated data from the manufacturers of these drugs.
The Medicare Part B payment limits for valid HCPCS codes that are not included in the quarterly ASP pricing files will be determined by the local Medicare contractor.
CMS guidance requires physicians and other providers to bill using the appropriate HCPCS or CPT code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy.
Effective January 1, 2017, payment for infusion drugs furnished through a covered item of DME will be based on Section 1847A of the Social Security Act, meaning that most of the payments will be based on the Average Sales Price of these drugs. The ASP Drug Pricing Files for 2017 and subsequent years will no longer contain columns for the Infusion AWP or the DME infusion limit. Unless otherwise specified, the Payment Limit in column D will be applied to payments for drugs infused through covered DME. Additional information of DME Infusion Drug Pricing is available through the DME MACs.