On June 9, 2023, the Centers for Medicare & Medicaid Services (CMS) issued its next list of Part B drugs subject to the Medicare Prescription Drug Inflation Rebate Program’s adjusted coinsurance rates (“Rebatable Drugs”) from July 1 through September 30 (“Q3 Rebatable Drug List”).
CMS intends to invoice manufacturers for the rebate penalty amounts imposed for increasing the prices of the Rebatable Drugs faster than the rate of inflation. CMS published the list of Part B Rebatable Drugs for the upcoming quarter as part of the Medicare Part B Drug and Biological Average Sales Price (ASP) Quarterly Payment file.
Inflation-Adjusted Coinsurance Percentages for Q3 Rebatable Drugs
NEWLY ADDED REBATABLE DRUGS FOR Q3
| ADCETRIS | 19.494% | LUPRON DEPOT-PED | 19.376% |
| AGGRASTAT | 19.483% | MONONINE | 19.929% |
| BLINCYTO | 19.331% | NPLATE | 19.718% |
| CRYSVITA | 19.812% | ONCASPAR | 19.129% |
| CUVITRU | 19.970% | PANHEMATIN | 19.461% |
| ENJAYMO | 19.825% | PROLIA | 19.829% |
| FOLOTYN* | 19.902% | SYNRIBO | 18.895% |
| GAMMAGARD S/D | 19.380% | TEZSPIRE | 19.899% |
| GAMMAPLEX | 19.155% | TROGARZO | 19.820% |
| IMLYGIC | 19.570% | VABOMERE | 19.828% |
| INFUGEM | 19.397% | VARIZIG | 19.560% |
| KYPROLIS | 19.685% | VECTIBIX | 19.646% |
| VIVITROL | 19.948% |
- Mircera and Sylvant—listed as Rebatable Drugs in Q2—were removed from the Q3 Rebatable Drug List.
- *Folotyn was included in the initial Rebatable Drug list for Q2 but removed from the final list.
DRUGS THAT CONTINUE TO BE REBATABLE DRUGS FROM Q2 TO Q3
| DRUG NAME | Q2 2023 FINAL LIST (3/29) |
Q3 2023 INITIAL (6/9) |
CHANGE FROM Q2 TO Q3 |
| ABELCET | 19.29% | 19.368% | 0.08% |
| AKYNZEO | 16.31% | 15.691% | -0.62% |
| ATGAM | 17.93% | 18.075% | 0.14% |
| AVEED | 19.35% | 18.825% | -0.53% |
| BICILLIN C-R | 19.03% | 17.573% | -1.46% |
| BICILLIN L-A | 18.62% | 17.233% | -1.39% |
| CARNITOR | 14.00% | 13.558% | -0.44% |
| CYTOGAM | 19.09% | 19.173% | 0.08% |
| FLEBOGAMMA DIF | 17.76% | 14.150% | -3.61% |
| FRAGMIN | 14.08% | 11.892% | -2.19% |
| HUMIRA | 19.64% | 19.720% | 0.08% |
| LEUKINE | 19.76% | 19.422% | -0.34% |
| MINOCIN | 19.40% | 19.079% | -0.32% |
| NIPENT | 17.37% | 18.882% | 1.51% |
| PADCEV | 19.59% | 19.658% | 0.07% |
| RYBREVANT | 19.86% | 19.990% | 0.13% |
| SIGNIFOR LAR | 18.51% | 19.049% | 0.53% |
| XIAFLEX | 19.07% | 19.101% | 0.03% |
Key Considerations
- CMS states that “[f]rom time to time, ASP public files need to be corrected or updated … based on feedback received after the files are published. If CMS receives feedback that necessitates updates to this list of drugs with adjusted coinsurance amounts, CMS will update the list,” which could occur “either before the start of the quarter or after in the event updated data becomes available.”
- Notably, CMS issued its first list of Part B Rebatable Drugs for Q2 on March 15, 2023, then later that month, CMS updated the Q2 Rebatable Drug list to remove seven drugs.
Next Steps for Stakeholders
- Manufacturers should evaluate whether to submit feedback to CMS about their Rebatable Drugs.
Related Documents
- Fact Sheet for Reduced Coinsurance for Certain Part B Rebatable Drugs – Applicable July 1 – September 30, 2023
- July 2023 Medicare Part B Drug and Biological Average Sales Price Quarterly Payment files
- Learn more about Part B inflation penalty rebates here.
Date of Issuance: June 9, 2023
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