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`2021 ASP Drug Pricing Files
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`ASP Drug Pricing Files October 2021 Update
`
`The files below contain the payment amounts that will be used to pay
`for Part B covered drugs for the fourth quarter of 2021. The October
`2021 ASP payment limits have been updated.
`
`Comparing the fourth quarter 2021 payment amounts with the prior
`quarter reveals that, on average, payment amounts for the top 50 Part
`B drugs decreased by 0.6 percent.
`
`For most of the higher volume drugs (36 out of the top 50), the prices
`changed 2 percent or less. Overall, the prices for 24 of the top 50
`drugs decreased. In general, among the top drugs with a decrease,
`there are a number of competitive market factors at work – multiple
`manufacturers, alternative therapies or market shifts to lower priced
`products.
`
`CMS remains interested in ensuring continued beneficiary access to
`Part B covered drugs. We will continue to monitor trends in pricing, as
`reflected by the published ASP payment rates, as well as utilization
`within the Medicare community.
`
`Where applicable, the payment amounts in the quarterly ASP files are
`106 percent of the Average Sales Price (ASP) calculated from data
`submitted by drug manufacturers. The quarter to quarter price
`changes are generally the result of updated data from the
`manufacturers of these drugs.
`
`The Medicare Part B payment limits for valid HCPCS codes that are
`not included in the quarterly ASP pricing files will be determined by the
`local Medicare contractor.
`
`CMS guidance requires physicians and other providers to bill using the
`appropriate HCPCS or CPT code and to accurately report the units of
`service. Physicians and other providers should ensure that the units
`billed do not exceed the maximum number of units per day based on
`the code descriptor, reporting instructions associated with the code,
`and/or other CMS local or national policy.
`
`Effective January 1, 2017, payment for infusion drugs furnished
`through a covered item of DME will be based on Section 1847A of the
`Social Security Act, meaning that most of the payments will be based
`on the Average Sales Price of these drugs. The ASP Drug Pricing
`Files for 2017 and subsequent years will no longer contain columns for
`the Infusion AWP or the DME infusion limit. Unless otherwise
`specified, the Payment Limit in column D will be applied to payments
`for drugs infused through covered DME. Additional information of DME
`Infusion Drug Pricing is available through the DME MACs.
`
`Section 405 of the Consolidated Appropriations Act, 2021 requires the
`Department of Health and Human Services (HHS) Office of the
`Inspector General (OIG) to conduct periodic studies on certain self-
`administered drugs or biologicals that are paid under the statutory
`payment limit, and permits CMS to apply a “lesser-of” methodology to
`the ASP calculation, if deemed appropriate. The Medicare payment
`amount for the drug or biological billing code would be the lesser of
`(“lesser of” methodology): (1) the payment limit determined using the
`current ASP+6% methodology, or (2) the ASP+6% amount obtained by
`excluding the self-administered products identified an OIG study.
`
`Section 405 also requires that beginning July 1, 2021, the ASP-based
`payment for billing codes that include certain self-administered
`products identified in a July 2020 OIG report (available at
`https://oig.hhs.gov/oei/reports/OEI-BL-20-00100.asp) be calculated
`using the “lesser of” methodology.
`
`To meet the implementation date of July 1, 2021 required by section
`405, CMS has applied the lesser-of methodology to the payment limit
`calculations for billing and payment codes representing certolizumab
`pegol and abatacept (J0717 and J0129, respectively). These have
`been incorporated into the July 2021 ASP Drug Pricing Files and a
`notation of the lesser-of methodology has been included in the July
`2021 ASP Pricing File.
`
`Downloads
`
`October 2021 ASP Pricing File (ZIP)
`October 2021 NOC Pricing File (ZIP)
`October 2021 ASP NDC-HCPCS Crosswalk (ZIP)
`July 2021 ASP Pricing File - updated 09/01/2021 (ZIP)
`July 2021 NOC Pricing File (ZIP)
`July 2021 ASP NDC HCPCS Crosswalk (ZIP)
`April 2021 ASP Pricing File - updated 09/01/2021 (ZIP)
`April 2021 NOC Pricing File (ZIP)
`April 2021 ASP NDC-HCPCS Crosswalk (ZIP)
`January 2021 ASP Pricing File - updated 09/01/2021 (ZIP)
`January 2021 NOC Pricing File (ZIP)
`
`Exhibit 2172
`Page 01 of 02
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`January 2021 ASP NDC-HCPCS Crosswalk (ZIP)
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`Page Last Modified: 09/09/2021 04:06 PM
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`Exhibit 2172
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`Page 02 of 02
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`Exhibit 2172
`Page 02 of 02
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