ASP Changes April 2023

April 2023 ASP Changes: Quarter 2 ASP

The ASP describes the real average price that a drug is being sold for including discounts. The ASP is listed at the HCPCS unit level and provides a reimbursement rate benchmark for prescription drugs in government programs, such as Medicare and Medicaid, as well as in private insurance plans. For this reason, it is crucial that ASP rates are carefully tracked and monitored. 

Every quarter, CMS publishes an updated ASP pricing file. This file can be found here: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/2023-asp-drug-pricing-files and includes several key pieces of information. The HCPCS Code, Short Description, HCPCS Code Dosage, and Medicare Payment Limit are all included in the quarterly ASP file. Interestingly, this file does not include the ASP, instead listing the Medicare Payment Limit. The Medicare Payment Limit is the amount which Medicare reimburses HCPCS-coded drugs, or ASP +6%. In order to calculate ASP, we subtract 6% from the Medicare Payment Limit. Please view our Glossary for more terms. 

Below, you will find a graph comparing ASP from January 1st, 2023 to April 1st, 2023. You can filter and search the graph for a HCPCS code or drug of choice.