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Commenters compared the language used in the Social Security Act for clotting factor and coverage of medical and other health services. Specifically, they noted section 1861(s)(2)(A) of the Act, which provides for Medicare Part B coverage of services and supplies (including drugs and biologicals which are not usually self-administered by the patient) furnished as an incident to a physician's professional service. Commenters stated that because the same exact words were not used to describe the limits of these two different subsets of coverage, that is, medical and other health services and clotting factor, then Congress could not have meant the same thing

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(2) assign ASP units equal to the lowest positive number of manufacturer-reported ASP units for any NDC in the grouped billing and payment code to each NDC that was sold or marketed during the applicable calendar quarter and for which the respective NDC lacks manufacturer-reported ASP units

2026;49:413-423 - routine-care cohort, semaglutide arm n=1,393, -8.8% at 6 months