Pricing & reimbursement

Medicare Part B drug

Definition

A drug covered under the medical benefit because it is administered by a clinician rather than self-administered.

Part B is where J-codes, ASP pricing and buy-and-bill live. The dividing line from Part D is not the drug but how it is given.

Medicare Part D drugA drug covered under the outpatient prescription benefit and dispensed by a pharmacy.Definition Self-administered drugA drug that a patient can reasonably administer themselves, which therefore falls outside the medical benefit.Definition ASP (Average Sales Price)The volume-weighted average price manufacturers actually realise for a drug, net of most discounts and rebates, reported quarterly to CMS.Definition

More in Pricing & reimbursement

340B program Allowed amount AMP (Average Manufacturer Price)ASP plus 6 percent AWP (Average Wholesale Price)Best price Bundled payment Contractual adjustment

All 153 terms Coding guide J-code directory