Payment Rate for 340B-Acquired Drugs in 2022 OPPS Final Rule Annulled
On September 28, 2022, the United States District Court for the District of Columbia annulled the differential payment rates for 340B-acquired drugs as outlined in the 2022 Outpatient Prospective Payment Final Rule. The ruling states the Centers for Medicare and Medicaid Services (CMS) cannot apply the average sales prices (ASP) minus 22.5 percent drug payment rate for these drugs for the rest of 2022. Therefore, CMS will revert to paying the default rate (typically ASP plus 6 percent) under the Medicare statute for 340B-acquired drugs.
CMS will upload revised OPPS drug files, applying the default rate to these drugs for the rest of the year. Additionally, CMS will reprocess claims paid on or after September 28, 2022, using the default rate.
