Advocacy & Practice Updates — Clinical Updates

CMS Announces Practices Must Begin Modifying Xipere Co-Pay Amounts April 1

This morning, CMSreleased a list of 27 Part B drugs that will be subject to rebates starting April 1 because the manufacturers raised prices at a level greater than inflation. The only retina-specific drug included on the list is Xipere. Since the manufacturer must rebate Medicare for the difference in the price beyond inflation, beneficiaries will incur a lower co-insurance. Medicare will keep physician practices whole and reimburse for the difference between ASP and the inflation-adjusted amount. Visit the CMS ASP page for guidance on billing and to download the 2nd quarter file. CMS plans to update the list of drugs and co-pay levels quarterly. 

CMS also released a factsheet on the inflation rebate program.  

Posted March 15, 2023