CMS may change Medicare Part B proposal after criticisms from Congress

The Centers for Medicare & Medicaid Services (CMS) is open to revising its proposal to change how physicians are reimbursed for drugs under Medicare Part B, said the agency’s CMO Patrick Conway, MD, according to The Hill.

The current plan calls for a five-year pilot program that would change the reimbursement calculation from the average sales price of the drug plus a 6 percent add-on fee to a new rate of the average price plus a 2.5 percent add-on, along with a flat fee of $16.80 per drug per day.

Speaking at a briefing hosted by the Alliance for Health Care Reform, Conway said the current proposal could be revised.

“The proposal was to remove financial considerations from the prescribing of medicine," Conway said. "That being said, if the proposal doesn't hit that point and we need to adjust it, we'd be open to that.”

The proposal has been met with resistance from both parties in Congress. After Republicans on the Senate Finance Committee wrote a letter to CMS asking the program be scrapped entirely, the minority Democrats on the same committee asked for specific concerns about the impact on rural physicians and potential disruptions in care to be addressed.

Members of the House have taken those concerns a step further: 242 congressmen, four of them Democrats, signed a letter asking CMS to withdraw the proposed rule. Taking a different approach, Reps. Larry Buchson, MD, R-Ind., and Bob Dold, R-Ill., have introduced legislation to block the program.

“We cannot allow unelected D.C. bureaucrats to run an experiment with Medicare beneficiaries that could disrupt care for the people who need medications most, including those with cancer, arthritis, and other diseases. Their unilateral decision to cut Medicare benefits will compromise the health of our nation’s most vulnerable,” the congressmen wrote. 

While Conway said at the briefing he’s willing to address those concerns, particularly the geographic scope of the program and its potential impact on rural or smaller practices, but reiterated one of the goals of the program is to remove what he sees as the current formula’s incentive for physicians to prescribe more expensive drugs.

“At a recent meeting [I attended] one doctor said that the ASP plus whatever wouldn't cover the cost [of one drug], so he wouldn't give it to a patient. That concerns me as a doctor,” Conway said.

Reaction from organizations has been mixed. Aetna and AARP released a joint letter May 2 supporting the proposal, according to The Hill, saying it “appropriately focuses on changing prescriber behavior while ensuring that Medicare beneficiaries can maintain access to the medications that they need.”

On the other side of the issue, the Pharmaceutical Research and Manufacturers of America have come out in opposition to the program.