On July 13, 2017, in its Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) issued a surprise proposal to reduce 340B reimbursement for certain Medicare Part B drugs purchased by 340B-eligible hospitals, hospitals, community mental health centers, and ambulatory surgical centers, starting January 2018. The Proposal indicates that the payment change is necessary to address growth in the number of providers participating in the 340B program, the potential for over utilization of drugs, and high drug prices with related increases in Medicare beneficiary cost-sharing. Hospitals and other affected providers will also have to identify Medicare claims for drugs purchased at the 340B discount with a new modifier.
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