Proposed change to Medicare Part B finding little support in Congress

A proposal for a five-year pilot program to reduce the 6 percent add-on to the average sales price (ASP) for reimbursement for Medicare Part B-covered drugs is being criticized by both Republicans and Democrats in Congress, according to the Hill.

CMS unveiled the pilot program in March, claiming “the current Medicare Part B drug payment methodology can penalize doctors for selecting lower-cost drugs.” The pilot program would reduce the reimbursement after the ASP from a 6 percent add-on to 2.5 percent plus a flat fee of $16.80 per drug per day.

Republicans serving on the Senate Finance Committee sent a letter to CMS asking it to withdraw the rule out of concerns providers would face costs over the Medicare payment amount and patients wouldn’t have access to drugs covered under Part B.

“This problem would likely be especially acute for small physician practices and practices in rural areas,” the senators wrote. “Physicians who have trouble accessing drugs at the reduced ASP payment would likely refer patients to the hospital outpatient department.”

A letter from Democrats on Finance Committee voiced similar concerns about the impact on rural physicians, potential disruptions in care and a lack of engagement with medical experts on crafting the rule. Rather than calling for the pilot program to be scrapped entirely, however, the group of Democrats asked for chance that specifically address their issues with the current proposal.  

“We appreciate CMS’s interest in testing strategies to improve value in all aspects of our health care system,” the Democratic senators wrote. “However, we have heard numerous concerns from patients, providers and other stakeholders about the model’s potential to have unintended consequences on Medicare beneficiaries’ access to care and physician-administered drugs.”

In the House, Rep. Larry Buchson, R-Ind., told the Hill he’s planning on introducing a bill to block the program from being implemented, and said he expects some Democrats to offer their supports.

Despite the issues both parties are raising with the proposal, HHS indicated it wants the program to move forward.

“The administration's Part B proposal seeks to deliver better value for consumers and Medicare, while ensuring that doctors and patients continue to have access to life-saving drugs,” HHS spokesman Ben Wakana said to the Hill, citing support from groups like AARP and the American Academy of Family Physicians.

The rule initiating the program could be finalized this summer.