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The HHS Office of Inspector General reviewed Part D plan formularies for 2026 and found that plans generally include drugs commonly prescribed to dual-eligible beneficiaries. The analysis examined formulary coverage patterns for medications frequently used by individuals enrolled in both Medicare and Medicaid. The report provides insight into whether dual eligibles have adequate access to needed medications through Part D coverage. This matters for Medicaid managed care organizations that coordinate benefits for dually eligible members and must ensure continuity of pharmacy coverage across programs.
The HHS Office of Inspector General released its quarterly comparison of Average Sales Prices (ASP) and Average Manufacturer Prices (AMP) for drugs covered under Medicare Part B for the fourth quarter of 2025. This routine report tracks whether ASPs exceed AMPs by specified thresholds, which can trigger federal payment adjustments under the Deficit Reduction Act. The data covers physician-administered drugs reimbursed through Medicare Part B fee-for-service, not Medicaid managed care pharmacy benefits. These quarterly reports are published regularly and do not indicate new policy changes or enforcement actions.
The HHS Office of Inspector General released its quarterly comparison of Average Sales Prices (ASP) and Average Manufacturer Prices (AMP) for drugs in the fourth quarter of 2025. This routine report identifies drugs where ASP exceeds AMP by specified thresholds, which triggers potential Medicaid reimbursement adjustments under federal law. The data covers Medicare Part B drugs and provides transparency into pharmaceutical pricing differentials that affect both Medicare and Medicaid programs. CMS uses these comparisons to determine when Medicaid best price penalties may apply.
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