Average Sales Price Resource Center
Effective January 1, 2017, as a result of the CURES Legislation, payment for DME Infused drug with be ASP+6%. This is a dramatic change for many of the drugs covered under the DME benefit. NHIA has compiled an analysis of showing the effects of the shift to the ASP+6% pricing methodology, which can be accessed by members here.
Background on ASP pricing methodology:
Effective January 1, 2005, Medicare implemented a new Average Sale Price-based methodology for certain Medicare Part B-covered drugs administered in physician offices as well IVIG and respiratory medications. NHIA members expressed serious concerns about how ASP will be interpreted by non-Medicare payers and whether these payers understand the impact ASP pricing would have on access to home infusion therapies. Members have also sought contractual strategies to reduce the risk that payers will implement sudden and arbitrary pricing changes. Up until the January 1, 2017 Medicare reimbursement for infusion drugs furnished in the home through an item of DME (except home IVIG) continued to be at 95% of AWP.