CMS’ Conway promises ‘adjustments’ to controversial Part B overhaul

While defending a proposal to test changes to how reimbursements are calculated under Medicare Part B, CMS Chief Medical Officer Patrick Conway, MD, told a panel of federal lawmakers the agency would alter the plan based on concerns from physicians and lawmakers.

“We are reviewing the comments now and plan to make adjustments in the final rule,” Conway said before the Senate Finance Committee.

Under the proposed rule, a five-year pilot program would test out a new reimbursement calculation for Part B drugs. 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 that.

CMS has argued the current system encourages physicians to prescribe higher-cost drugs, but members of Congress from both parties have wondered whether it will disrupt care for patients with serious conditions and restrict drug choices through rural physicians.

“From the day CMS made their proposed demonstration public this past March, I have made my opinion very clear:  I believe this experiment is ill-conceived and likely to harm beneficiaries,” said Senate Finance Committee Chairman Orrin Hatch, R-Utah. “It is an overreach on the part of CMS that, in my opinion, goes beyond the agency’s statutory authority, extends nationwide, and requires all Medicare Part B providers to participate.”

Republicans on the committee had sent CMS a letter in May asking for the program to be scrapped entirely, and Hatch said to Conway the response from the agency amounted to a “form letter.”

Conway declined to answer a question about whether CMS has considered dropping the rule.

Democrats on the committee haven’t gone as far in their criticism, but did send their own letter months ago asking for changes to ensure the program doesn’t cut off access to prescriptions for Medicare beneficiaries, or drive those patients to more expensive providers.

“It’s extremely important that the project not result in patients being told that they have to go get treatment at the hospital, where treatment is typically more costly and less convenient,” said Sen. Ron Wyden, D-Ore., the ranking Democrat on the committee.

Conway said access to drugs is “a priority for CMS,” but didn’t provide many specifics on what adjustments the agency is considering to address those concerns, only saying the scope of the program and the new reimbursement calculation may be altered in the final rule.