In March, CMS proposed a new payment method for Medicare B drugs, which will try out payment methods in different geographic locations to compare results in various parts of the country.
Some of the proposed changes include:
• Lowering the add-on payments from 6 percent to 2.5 percent with an additional $16.80 flat payment
• Decreasing or eliminating patient cost-sharing
• Analyzing physicians' prescribing patterns to create decision-support tools to help provide patients with the safest and most appropriate drug choices
The proposal drew resistance from various medical groups and legislators. Early in May, a group of 242 legislators implored the Obama administration to get rid of its proposed payment changes to Medicare Part B. Democratic House members including Reps. Brad Ashford (Neb.), Dutch Ruppersberger (Md.), Kyrsten Sinema (Ariz.) and Collin Peterson (Minn.) signed the letter. The letter cautions the program may harm patients by limiting access to treatment.
Also in May, Patrick Conway, MD, a CMS official, said CMS would work with Congress to ensure the proposal applies only to a smaller geographic area and will make sure the proposal does not negatively impact rural or smaller providers. Dr. Conway maintained the agency's stance behind the updates, saying, "We do think value-based work in the drug space is important."
On June 28, an administration official told Congress the federal government would update the proposal to address various concerns. While the administration said it will make various adjustments, the administration stands behind the overall proposal and will likely implement the payment updates, according to The Hill.
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