APR 06, 2023
CMS Updates Part B Rebate Drug List, Removing Only Ophthalmic Drug
The Centers for Medicare & Medicaid Services (CMS) has published a corrected final list of drugs selected for its coinsurance rebate program that began April 1, dropping the macular edema drug Xipere (HCPCS J3299, triamcinolone acetonide injectable suspension).
With the correction issued last week, the agency narrowed its list from 27 to 20 drugs.
CMS had initially selected Xipere among the first 27 Part B drugs and biologicals.
Under the program, Medicare patients get reduced coinsurance payments for these drugs on an ongoing quarterly basis. However, provider reimbursements will be maintained at current rates.
As CMS explains in the program fact sheet, the agency will keep providers whole by paying the difference between the Medicare-allowed amount and the reduced beneficiary coinsurance.
Part B drugs and biologicals may be added or removed each quarter depending on prices set by manufacturers, and patients’ coinsurance payments may vary from quarter to quarter.
Physicians can monitor quarterly drug prices on the CMS Medicare Part B drug average sale price webpage.