What is a pass-through?

Pass-through drugs are reimbursable in order to facilitate patient access to innovative drugs that may be expensive to develop and market. The pass-through payment mechanism allows Medicare to reimburse hospitals and ASC’s for the all or part of the cost of these drugs, without having to wait for the drug's market price to stabilize. This helps to ensure that patients have access to these drugs, even if they are not yet widely available or affordable.

Pass-through status is typically granted to new drugs that are breakthrough therapies, or that treat serious or life-threatening conditions. The drug must also have high costs relative to the OPPS payment rate for the associated service.