Physicians criticize Medicare Part B proposal at hearing

Along with finding little support in Congress, a proposed change to reduce reimbursement rates under Medicare Part B was largely panned by medical professionals who testified before the House Energy and Commerce Committee May 17.

As introduced by CMS in March, the proposal would establish a five-year pilot program to test out a new reimbursement calculation. Instead of physicians being paid a 6 percent add-on fee after the average sales price (ASP), they would receive a 2.5 percent add-on plus an additional $16.80 per drug per day after the ASP.

While CMS has argued the current payment system encourages physicians to prescribe more expensive drugs, one witness called before the committee said there are few situations in cancer care where an equally effective but lower cost drug would be available.

“The CMS experiment has the potential to affect treatment options and outcomes for the most significant and vulnerable segment of the population fighting cancer,” said Debra Patt, MD, MPH, a vice president of Texas Oncology. “Interfering with a physician’s ability to act in the patient’s best interest is counter to our core values.”

Patt also criticized CMS in her written testimony for supposedly not engaging with physicians on crafting the proposed rule, saying it hasn’t provided evidence of physicians “choosing higher priced drugs as opposed to appropriate therapeutic treatment,” the very reason CMS has said the program is necessary.

The plan did have its supporters at the hearing among groups representing patients and patients themselves.

“I want to know that the drugs that are being used to treat my cancer are the ones that will do the best job and not just make my doctor the most money,” said patient advocate Heather Block. “Every patient deserves that, and in all of the uproar about the proposal, I have yet to hear anyone say the current system is working.”

Among members of Congress, the proposal has been criticized by members of both parties. Four Democrats joined 242 Republicans in the House to send a letter to CMS asking for the rule to be withdrawn, which was echoed by some of the witnesses.

“I think this proposal needs to be pulled back completely,” Patt said. “I think we would really look forward to working with CMS on better value models.”

Both Republican and Democrats on the committee expressed concerns about the plan, with Republicans leaning toward scrapping it entirely and most Democrats calling for modification, though there were some legislators who supported the plan moving forward as is.

“Any time we try to do anything to rein in drug costs, we are met with fierce opposition,” said Rep. Jan Schakowsky, D-Ill. “All we hear today is ‘no,’ with no alternative ideas.”

The CMO for CMS, Patrick Conway, MD, has indicated the agency is open to revising parts of the proposal.