On September 28, 2022, the United States District Court for the District of Columbia vacated the differential payment rates for 340B-acquired drugs in the Calendar Year 2022 Outpatient Prospective Payment System (OPPS) final rule with respect to their prospective application. The Court ruled:
- The U.S. Centers for Medicare & Medicaid Services (CMS) can’t apply the average sales price (ASP) minus 22.5% drug payment rate for these drugs for the rest of the year
- As a result, CMS will revert to paying the default rate (generally ASP plus 6%) under the Medicare statute for 340B-acquired drugs
CMS is uploading revised OPPS drug files that will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year. CMS also will reprocess claims our contractors paid on or after September 28, 2022, using the default rate (generally ASP plus 6%).
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
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