Health Law Daily Wrap Up, PRESCRIPTION DRUGS—OIG REPORTS: OIG flags inflated Omvoh Part B payments, (Apr 6, 2026)

By Martin A. Steinberg, J.D.

Excluding Omvoh’s noncovered self-administered versions would have reduced the drug’s fourth-quarter 2024 Part B payment amount by 15 percent.

A March 2026 HHS Office of Inspector General data brief found that Medicare Part B payments for Omvoh in the second half of 2024 included noncovered self-administered versions of the drug, increasing payment amounts for the covered provider-administered vial. Omvoh is used to treat moderate-to-severe active ulcerative colitis and Crohn’s disease. According to the OIG, excluding those self-administered versions would have lowered Omvoh’s fourth-quarter 2024 payment amount by 15 percent, or $1,742 per vial. The brief also reported that CMS’s removal of noncovered self-administered versions of five previously identified drugs— Orencia, Cimzia, Fasenra, Xolair, and Tezspire — saved Part B and beneficiaries $1.3 billion from 2023 through 2024. OIG said CMS should now use its statutory authority to remove Omvoh’s self-administered versions from future payment calculations where doing so would reduce payment amounts (OIG Data Brief, OEI-BL-25-00110, March 2026).

Covered and noncovered versions included. OIG found that CMS used both the covered provider-administered vial of Omvoh and the noncovered self-administered pen and syringe versions to set ASP-based Part B payment amounts in the second half of 2024. The vial is administered by a provider during the induction phase, while the prefilled pen and syringe are used by patients during maintenance treatment. Medicare Part B and its enrollees paid a total of $1.2 million for Omvoh in 2024.

Increased Omvoh’s payment amounts. OIG said the inclusion of self-administered versions raised Omvoh’s reimbursement rate. In the third quarter of 2024, excluding the self-administered prefilled pen would have reduced the payment amount per vial from $10,423 to $10,145, a 3 percent decrease. In the fourth quarter of 2024, after CMS also included the self-administered prefilled syringe, excluding both self-administered versions would have reduced the payment per vial from $11,863 to $10,121, a 15 percent decrease.

Savings of $1.3 Billion. OIG also reported that CMS had already removed noncovered self-administered versions of five previously identified drugs—Orencia, Cimzia, Fasenra, Xolair, and Tezspire — from payment calculations, as required by statute. Those exclusions saved Medicare Part B and beneficiaries $1.3 billion from 2023 through 2024. The largest savings came from Orencia and Cimzia, which accounted for 97 percent of the total. For example, the fourth-quarter 2024 payment amount for a typical 750 mg Orencia injection fell 31 percent, from $4,706 to $3,258, and the payment amount for a typical 400 mg Cimzia injection fell 40 percent, from $3,083 to $1,861.

Recommended next step. Congress requires OIG to identify Part B billing codes that combine covered provider-administered drugs with noncovered self-administered versions and to assess whether the noncovered versions should be excluded from payment calculations. CMS should now use its statutory authority, exercising its discretion as permitted, to remove Omvoh’s self-administered versions from payment amount calculations in subsequent quarters if the exclusion would result in lower payment amounts.

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