Pub. L. 110-173, tit. I, sec. 112

PAYMENT FOR PART B DRUGS.

EnactedYear: 2007Length: 508 wordsOfficial source
SEC. 112. PAYMENT FOR PART B DRUGS.(a) Application of Alternative Volume Weighting in Computation of ASP.—Section 1847A(b) of the Social Security Act (42 U.S.C. 1395w–3a(b)) is amended—(1) in paragraph (1)(A), by inserting “for a multiple source drug furnished before April 1, 2008, or 106 percent of the amount determined under paragraph (6) for a multiple source drug furnished on or after April 1, 2008” after “paragraph (3)”;(2) in each of subparagraphs (A) and (B) of paragraph (4), by inserting “for single source drugs and biologicals furnished before April 1, 2008, and using the methodology applied under paragraph (6) for single source drugs and biologicals furnished on or after April 1, 2008,” after “paragraph (3)”; and(3) by adding at the end the following new paragraph:“(6) Use of volume-weighted average sales prices in calculation of average sales price.—“(A) In general.—For all drug products included within the same multiple source drug billing and payment code, the amount specified in this paragraph is the volume-weighted average of the average sales prices reported under section 1927(b)(3)(A)(iii) determined by—“(i) computing the sum of the products (for each National Drug Code assigned to such drug products) of—“(I) the manufacturer’s average sales price (as defined in subsection (c)), determined by the Secretary without dividing such price by the total number of billing units for the National Drug Code for the billing and payment code; and“(II) the total number of units specified under paragraph (2) sold; and“(ii) dividing the sum determined under clause (i) by the sum of the products (for each National Drug Code assigned to such drug products) of—“(I) the total number of units specified under paragraph (2) sold; and“(II) the total number of billing units for the National Drug Code for the billing and payment code.“(B) Billing unit defined.—For purposes of this subsection, the term ‘billing unit’ means the identifiable quantity associated with a billing and payment code, as established by the Secretary.”.(b) Treatment of Certain Drugs.—Section 1847A(b) of the Social Security Act (42 U.S.C. 1395w–3a(b)), as amended by subsection (a), is amended—(1) in paragraph (1), by inserting “paragraph (7) and” after “Subject to”; and(2) by adding at the end the following new paragraph:“(7) Special rule.—Beginning with April 1, 2008, the payment amount for—121 STAT. 2501 “(A) each single source drug or biological described in section 1842(o)(1)(G) that is treated as a multiple source drug because of the application of subsection (c)(6)(C)(ii) is the lower of—“(i) the payment amount that would be determined for such drug or biological applying such subsection; or“(ii) the payment amount that would have been determined for such drug or biological if such subsection were not applied; and“(B) a multiple source drug described in section 1842(o)(1)(G) (excluding a drug or biological that is treated as a multiple source drug because of the application of such subsection) is the lower of—“(i) the payment amount that would be determined for such drug or biological taking into account the application of such subsection; or“(ii) the payment amount that would have been determined for such drug or biological if such subsection were not applied.”.
Pub. L. 110-173, tit. I, sec. 112: PAYMENT FOR PART B DRUGS. | Justis AI