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Outpatient Prospective Payment System (OPPS) - Redetermination Requests for Drugs Acquired under 340B Program

340B Acquired Drugs

The 340B drug pricing program is a federal program that allows certain federally designated healthcare entities to purchase drugs at a discounted rate. As of January 1, 2018, Medicare reimburses hospitals that bill under OPPS at a rate of the Average Sales Price (ASP) - 22.5 percent for drugs purchased through the 340B Drug Program.

Appeals

In accordance with Medicare's national payment policy for drugs acquired under the 340B drug program, drugs reimbursed under OPPS are not eligible for an administrative review. Appeal requests received by CGS Administrators will be dismissed.

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