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We note that the cost sharing amounts of rebatable drugs paid under the OPPS published in the quarterly Addendum A and B updates reflect the inflation-adjusted coinsurance applied as a percent of the payment amount that would otherwise apply in accordance with section 1847A(b)(1)(B) or (C) of the Act, as determined by the Secretary pursuant to 1847A(i)(5) of the Act using the methodology in 427.201

In this model, the pharmacy bills the patient or their insurance directly

Many athletes continue training at 80-90% capacity, scaling or substituting movements that aggravate the injury