Drug Margin
Part B buy-and-billPart B buy-and-bill economics. Medicare pays the ASP payment limit (ASP + 6%) per drug; the 2% sequester trims only the Medicare-paid share. Your margin is what you net minus your acquisition cost. Enter your cost to see your real spread. Nothing is stored, no PHI.
CMS sets the allowed at ASP + 6%. After the 2% sequester on the Medicare-paid portion, the net add-on lands near ASP + 4.3% at standard 20% coinsurance. You keep the spread between that and what you actually pay to acquire the drug. Commercial payers may pay more.
Entered here only, never stored. No PHI.
Source: CMS Average Sales Price payment-limit file · public, updated quarterly · per the HCPCS billing unit shown. Medicare-based; commercial payers negotiate separately. Modeled, never a guarantee.
Book a discovery call to map this across your actual billed J-code volume and your commercial contracts, identifying the drugs where your real spread is thinnest. Unlock every CPT (the locked codes show more documented opportunity), your renewal calendar (so you fix it before the contract auto-renews), and signable leverage memos (the evidence you send the payer).
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