---
kind: "section"
citation: "42 C.F.R. § 427.201"
title: "42"
number: "427.201"
heading: "Computation of beneficiary coinsurance and adjusted Medicare payment for Part B rebatable drugs with price increases faster than inflation."
url: "https://uscodex.org/cfr/42/427.201"
---

# §427.201. Computation of beneficiary coinsurance and adjusted Medicare payment for Part B rebatable drugs with price increases faster than inflation.

- (a) **Methodology.** CMS must use the methodology set forth in this section to calculate the inflation-adjusted beneficiary coinsurance and associated adjusted Medicare payment percentage for Part B rebatable drugs as set forth in §§ [410.152(m)](/cfr/42/410.152.md?p=m), [419.41(e)](/cfr/42/419.41.md?p=e), and [489.30(b)(6)](/cfr/42/489.30.md?p=b-6) of this chapter.
- (b) **Calculation of inflation-adjusted beneficiary coinsurance.** To calculate the inflation-adjusted beneficiary coinsurance for Part B rebatable drugs with respect to a calendar quarter, CMS compares the payment amount, as set forth in [paragraph (b)(3)](#b-3) of this section, to the inflation-adjusted payment amount for the applicable calendar quarter.
  - (1) If the payment amount exceeds the inflation-adjusted payment amount, the inflation-adjusted beneficiary coinsurance is calculated by multiplying the inflation-adjusted payment amount by 0.20.
  - (2) If the inflation-adjusted payment amount does not exceed the payment amount, the adjustment to the beneficiary coinsurance set forth in [paragraph (b)(1)](#b-1) of this section is not applied.
  - (3) CMS will use the published payment amount in quarterly pricing files published by CMS as the payment amount in this determination.
- (c) **Exclusions.** Any drug that is excluded from Part B rebatable drugs as set forth in [§ 427.101(b)](/cfr/42/427.101.md?p=b) is not subject to inflation-adjusted beneficiary coinsurance.

## Notes

### Authority

Authority: 42 U.S.C. 1395w-3a(i), 1302, and 1395hh.

### Source

Source: 89 FR 98578, Dec. 9, 2024, unless otherwise noted.