Outpatient Prospective Payment System (OPPS): Redetermination Requests for Drugs Acquired under 340B Program

Published 04/23/2021

340B Acquired Drugs
The 340B drug pricing program is a federal program that allows certain federally designated healthcare entities to purchase drugs at a discounted rate. As of January 1, 2018, Medicare has reimbursed hospitals who bill under OPPS at a rate of the average sales price (ASP), 22.5 percent, for drugs purchased through the 340B Drug Program.

In accordance with Medicare’s national payment policy for drugs acquired under the 340B drug program, drugs reimbursed under OPPS are not eligible for an administrative review. Appeal requests received by Palmetto GBA will be dismissed.

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