On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) released the final rule ‘Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the Calendar Years 2018–2022‘. The rule addresses the agency’s plan to restore payments to certain hospitals impacted by a 2018 decision to reduce compensation on 340B-acquired drugs under the Outpatient Prospective Payment System (OPPS).
This latest development is a direct response to an opinion from the Supreme Court of the United States, which found significant problems with the previous approach adopted by the CMS. Details of the objections raised by the Supreme Court were undisclosed in the brief overview provided.
The original 2018 decision by the CMS was controversial, as it significantly cut reimbursement amounts for 340B drugs to hospitals under the OPPS. The 340B program enables eligible healthcare providers to purchase outpatient drugs at discounted prices. The decision had a significant economic impact on hospitals, especially those serving low-income communities.
With the implementation of the ‘Medicare Program; Hospital Outpatient Prospective Payment System: Remedy for the Calendar Years 2018–2022’ rule, these hospitals are expected to gain some degree of financial relief. The precise impact of this rule on the broader healthcare industry, however, remains to be fully seen.