On November 13, 2017, Centers for Medicare & Medicaid Services (CMS) within the U.S. Department of Health and Human Services (HHS) published the final rule revising the Medicare hospital Outpatient Prospective Payment System (OPPS) for CY2018. Among a number of changes, the final rule dramatically reduces Medicare Part B payments to hospitals for separately payable drugs purchased at a discount through the 340B Program by an average of 28%. Currently, Medicare pays hospitals the Average Sales Price (ASP) plus 6% for a separately payable drugs (ASP+6%) regardless of whether the hospital purchased the drug at a discount through the 340B Program. Under the final rule, Medicare will pay hospitals ASP minus 22% for separately payable drugs purchased through the 340B Program. The change will reduce payments to 340B hospitals by an estimated US$1.6 billion that will be redirected to payment for other services within the OPPS.
If you would like to discuss any of the details or implications of this matter for your business, please speak to one of the individuals listed in this publication or your usual contact at the firm.
