Medicare Part B: Coverages and Rebate and Pricing Essentials, hosted by American Conference Institute

This session will cover:

• Identifying drug coverages under Medicare Part B
• Understanding Part B pricing methodologies, coverage and coding
  • Average Sales Price (ASP)
  • Recognizing the differences in coverage, pricing and coding among various outpatient settings
• Calculation of ASP
  • Inclusions and exclusions
  • Exempt and non-exempt sales
  • Smoothing
  • The three-quarter lag
  • Free goods 
  • Patient assistance
• Submission of ASP data: timing
  • OIG and state AG efforts to obtain data
  • How late filed ASPs are dealt with when calculations are done?
  • Impact of COVID relief fund provisions on reporting
• Bundling
• Special concerns for radiopharmaceuticals
• Reimbursement under Part B
  • Most Favored National Model
• Reimbursement of generic specialty drugs
• Biosimilars