The Centers for Medicare & Medicaid Services (CMS) is open to revising its proposal to change the way physicians are paid for drugs administered under Medicare's Part B program, a CMS official said Wednesday. From MedPage Today.
The Centers for Medicare & Medicaid Services (CMS) is open to revising its proposal to change the way physicians are paid for drugs administered under Medicare's Part B program, a CMS official said Wednesday.
"The proposal was to remove financial considerations from the prescribing of medicine," CMS chief medical officer Patrick Conway, MD, told reporters at a briefing sponsored by the Alliance for Health Reform, Health Affairs, and the Jayne Koskinas Ted Giovanis Foundation for Health and Policy. "That being said, if the proposal doesn't hit that point and we need to adjust it, we'd be open to that."
The CMS plan would replace the current Medicare reimbursement -- the average sales price of the drug plus a 6% add-on fee to cover costs -- with a rate of the average sales price (ASP) plus 2.5%, plus a flat fee of $16.80 per drug per day. The flat fee would be adjusted at the beginning of each year.
When the plan was announced in March, physician groups, particularly in oncology, quickly attacked it as a reimbursement cut. The controversy has been continuing, with members of Congress and the Obama administration both jumping into the fray.
At the briefing, Conway noted that "for some of these practices, the drug revenue is over half of their revenue. I think" -- he paused for a few seconds -- "one could call that interesting."
Although most physicians do prescribe medications based on what's best for their patients, Conway said, "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."
CMS has a "first principle" that prioritizes patients having access to medication, he continued. "There is nothing in this proposed rule that limits access to any medication that we are aware of. If [it does], we want that to be identified" so it can be taken care of.
For example, "For small rural oncology practices, will this cover the provision of drugs?" Conway said. "We proposed it; we thought it did, but if it turns out it doesn't in certain situations -- classes, types of practices, or across the board -- we would be open to adjustments."
Asked by MedPage Today why the proposed changes to the Part B drug payment system didn't mimic the system used for drug payment under Part D -- a system that some analysts say produces more price competition for drugs -- Conway replied that Part D "has a different statutory construct; it was set up in law through the private health plan market."
However, he added, "[our] proposals we think would align with some principles in Part D ... Part D plans focus on value and outcomes for beneficiaries; we think it aligns with that principle."
"In Part D, competition and paying based on outcomes is part of the construct; we think this [proposal] would instill some of those principles or test them in Part B," he added. "We are attempting to apply some of the principles from Part D and the private market generally into the Part B drug space."
Improving Part B drug reimbursement is challenging, Conway said. "I was named in a Change.org petition where I got email about every 20 seconds from patients saying their doctor said they wouldn't get their medicine" under this plan. As a practicing physician, "it bothered me personally; it was clear that was not what this proposal is intended to do. It was disappointing they were hearing that from people in the healthcare system."
One issue that has come up in the comments has been whether to include in the Part B proposal those practices that are participating in CMS's new oncology care model, which is "an episode-based model that also includes a payment per beneficiary per month for care coordination," he said. "We said in the proposed rule that you could include [those] practices in the model or exclude them ... We have received some public input suggesting that we consider excluding those practices because they're in a total-cost-of-care model, so we'll have to consider that."