Medicare Part B Reimbursement (OK SPA 23-0011 & APA WF 23-15)

Effective July 1, 2023, the Oklahoma Health Care Authority (OHCA) will seek approval of a State Plan amendment to align reimbursement for certain biosimilar products with the Medicare Part B fee schedule. The Inflation Reduction Act (2022) included a provision directing Medicare Part B to increase reimbursement for certain biosimilar products from Average Sales Price (ASP) + 6% to ASP + 8%. Based on CMS guidance, OHCA is amending the State Plan and rules to replace specific references to ASP + 6% with language indicating payment will match Medicare Part B’s fee schedule.

Please view the circulation document here: APA WF # 23-15

Please view the draft SPA pages here: OK SPA 23-0011

Feedback may be submitted via the comment box.

Tribal Consultation: 6/6/23

60-Day Tribal Consultation Period: 5/26/23 – 7/25/23

Circulation date: 5/26/23

Comment Due Date: 6/25/23

Medical Advisory Committee (MAC) Meeting: 9/7/23

Board Meeting: 9/20/23