Effective Date: October 1, 2008

Implementation Date: October 6, 2008

Medicare contractors have been instructed to download and implement the October 2008 average sales price (ASP) and NOC drug pricing files for Medicare Part B drugs. In addition, if released by the Centers for Medicare & Medicaid Services (CMS), Medicare contractors should also download the revised July 2008, April 2008, January 2008, and October 2007 files.

The ASP methodology is based on quarterly data that drug manufacturers submit to CMS, which CMS then provides to contractors through the ASP drug pricing files for Medicare Part B drugs. Please note that payment allowance limits under the outpatient prospective payment system (OPPS) are incorporated into the outpatient code editor (OCE) through separate instructions.

Beginning January 1, 2008, under the OPPS, payment allowance limits for specified covered outpatient drugs are paid based on 105 percent of the ASP. Drugs and biologicals with pass-through status under the OPPS continue to have a payment allowance limit of 106 percent of the ASP. CMS will update the payment allowance limits quarterly. Exceptions are summarized in this article.

On or after September 16, 2008, the October 2008 ASP file will be available for download along with revisions to prior ASP payment files, if CMS determines that revisions to these prior files are necessary. On or after September 16, 2008, the October 2008 ASP NOC files will be available for retrieval from the CMS ASP Web page along with revisions to prior ASP NOC files, if CMS determines that revisions to these prior files are necessary.

Additional information is available on the CMS Web site. Here is the link to the MLN Matters article MM6175 .