CMS restores 340B drug acquisition reimbursement

Pursuant to the Supreme Court’s decision in AHA et al. v. Becerra, decided on June 15, 2022, the U.S. Court for the District of Columbia ruled in September that the Centers for Medicare & Medicaid Services (CMS) must stop applying the average sales price (ASP) minus 22.5% drug payment rate for drugs acquired by 340B hospitals in calendar year 2022. CMS must revert to paying 340B hospitals the default rate (ASP plus 6%) for 340B-aquired drugs.

CMS is currently uploading the newly revised Outpatient Prospective Payment System (OPPS) drug files that apply the default rate to 340B-aquired drugs for the rest of calendar year 2022. CMS will also reprocess all claims paid on or after September 28, 2022 using the same default rate.

This is welcome news for 340B entities around the nation, most of which are suffering through difficult financial times with reduced volumes and higher costs.

For more information, see this Medicare Learning Network Connects newsletter.