Hospital Outpatient Prospective Payment System Update on Payment Rates for Drugs Acquired through the 340B Program – INFORMATIONAL for MAOs

Relevant to:  All Medicare Advantage Organizations, Prescription Drug Plans, Cost Plans, PACE Organizations, and Demonstrations

 This Memorandum provides an update to Medicare Advantage Organizations (MAOs) on the Medicare Hospital Outpatient Prospective Payment System (OPPS) payment rates for drugs acquired through the 340B program on claims paid on or after September 28, 2022, in light of the June 15, 2022 Supreme Court decision in American Hospital Association v. Becerra. The Supreme Court ruled that HHS may not vary payment rates for drugs and biologicals among groups of hospitals in the absence of having conducted a survey of hospitals’ acquisition costs.

Click here to download the full guidance as a PDF.