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In such situations, for consistency, CMS will use the initial drug identified by the manufacturer in the last quarter of the Part D inflation rebate applicable period to identify the initial drug for the line extension drug alternative inflation rebate calculation

We also believe maintaining the performance threshold at 75 points for the 2027 MIPS payment year would provide us time to incorporate the impacts of this proposed cost performance category scoring methodology (if finalized) as we establish future performance thresholds

To illustrate how this cost performance category score could lower the final score, if this MIPS eligible clinician received perfect scores in each of the other three performance categories, based on the final score calculation under 414.1380(c) and the respective performance category weights when all four performance categories are scored without reweighting, we would use the formula as described below