What is CMS position regarding brand vs. generic drugs?
A78. Where drugs are indicated and the submitter has not priced drugs, or where a submitter prices for a generic drug where there is none, CMS will compare the MSA proposal to average wholesale price for brand name drugs. If drugs are indicated, but the medical and other records are silent or unclear about whether a Claimant is taking a brand or generic drug and both versions exist, then CMS will compare the MSA proposal to the generic drug where the submitter has proposed a generic drug, and CMS will compare the MSA proposal to the brand name drug where the submitter has proposed a brand name drug or has not proposed a drug at all.
