Pharmacy Question for the Week of August 13, 2018

Pharmacy Compliance Question of the Week

Question:

If a drug is not listed in the Medicare ASP or NOC file, does that mean it’s not covered?

Answer:

For drugs or biologicals not listed in the average sales price (ASP) or not otherwise classified (NOC) drug-pricing files, Medicare administrative contractors (MACs) determine the payment allowance limits in accordance with the policy described in Chapter 17, Section 20.1.3, of the Medicare Claims Processing Manual at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf. The discussion about ASP or NOC files starts in the fourth paragraph.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.