Medicare is a health insurance program for people age 65 or older, under age 65 with certain disabilities, and people with end-stage renal disease. The program is administered by the federal government through the Centers for Medicare and Medicaid Services (CMS). The program is divided into several parts—A, B, C, and D. Click on the links below to learn more about each part of Medicare.
- Part A — Hospital Insurance
- Part B — Medical Insurance
- Part C — Medicare Advantage
- Part D — Perscription Drug Coverage
Average Sales Price (ASP)
Medicare provides reimbursement for drugs administered in the office by a physician. However, drugs are not considered part of the Medicare Physician Fee Schedule. The Centers for Medicare and Medicaid Services (CMS) uses a separate methodology, known as the average sales price (ASP), to reimburse for Part B drugs. ASP was established by the Medicare Modernization Act (MMA). As part of ASP, CMS requires manufactures to submit price information each quarter. (This information is proprietary and not available to the public.) Based on the data received, CMS calculates a reimbursement amount for each drug and publishes the amounts on a quarterly basis.