Inclusion of Maximum Fair Price in Average Sales Price
The CMS is proposing to clarify and codify that units of drug sold or paid at the Maximum Fair Price (MFP) are to be included in the calculation of Average Sales Price (ASP). This aligns ASP treatment with Medicaid’s “best price” framework. Furthermore, under Medicare negotiation provisions, when a drug is under negotiation, MFP replaces ASP in quarterly payment files, meaning no ASP-based payment limit will be published for those negotiated drugs.
MFPs are likely to be lower than current ASPs for Part B drugs, which are currently calculated as a manufacturer’s ASP across a number of eligible entities, including providers, commercial insurers and Medicare Advantage plans. Inclusion of MFPs in the calculation of ASP is likely to pull ASPs downward.
Therefore, the ACR strongly encouraged the CMS to not move forward with this provision. If the CMS chooses to move forward with it, the ACR recommends that the CMS create a reimbursement floor so that ASP reductions from MFP do not push reimbursement below drug acquisition and administration costs.
Quality Payment Program
The following are some of the changes the CMS is proposing to MIPS for CY 2026:
- The CMS is proposing to maintain the performance threshold at 75 points for CY 2026. It are proposing to maintain this threshold through the CY 2028 performance period.
- The CMS is not proposing to change the weights for the performance categories. The quality performance category will be weighted at 30% and the cost performance category will be weighted by 30%. The promoting interoperability and improvement activities performance categories will maintain their respective 25% and 15% weights.
- The CMS is proposing to expand the portfolio of available MVPs and is revising the format of each MVP (including the ACR’s Advancing Rheumatology Care MVP) to categorize the quality measures by clinical conditions or episodes of care.
- The CMS will be introducing a new format of the MVP tables in 2026 to stratify quality measures by clinical conditions and/or episodes of care for each MVP, identified as “Clinical Groupings.”
- The CMS is proposing to require multispecialty groups to report MVPs either as subgroups or as individuals, rather than as a single group entity.
The ACR expressed support for the first four, but not the last. Maintaining the option for group-level MVP reporting, particularly for practices that can demonstrate meaningful quality improvement through aggregated data, would preserve flexibility and reduce unnecessary burden.