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

3rd Party Hosted Event
Date: 8 November 2021
Time: 1:00 PM ET
Location: via Webinar

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

American Conference Institute

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