The pressure is on for the CMS to transform, or even drop its recent proposal to change the way Medicare pays hospitals and doctors for outpatient drugs.
More than 600 comments on the Medicare Part B plan flooded the agency before the May 9 deadline, and most of them were negative. Members of Congress from both sides of the aisle asked the CMS to back away from the idea.
“The Part B Drug Payment Model is ill-conceived. It implies that physicians and their practices are the cause of high medical costs,” Dr. Bruce Hayton, an oncologist in Wildomar, Calif., said in a letter.
The CMS proposed dropping payment from 6% to 2.5% on top of a drug's average sales price and adding a flat payment of $16.80 per drug a day. The program would later add value-based options, including changing payment based on clinical effectiveness, and setting a standard rate for therapeutically similar drugs.
Opponents of the rule argue that access is at the root of their concerns, but policy analysts note that providers earn substantial revenue from Medicare's current and long-standing reimbursement method.
The CMS estimated in the proposal that Part B payments to oncologists—$1.2 billion in 2014—would decline by 0.7%, compared with a 1.3% increase across all specialties.
Major health plans, including Aetna, are urging the CMS to move forward.
“We believe (the proposal) will incentivize providers to choose less-expensive drugs when they are able to do so. It may also have a spillover effect—if fewer providers opt for higher-cost drugs when alternatives are available, manufacturers may lower drug prices over time,” Aetna said in a letter.
CMS' Chief Medical Officer, Dr. Patrick Conway, said the agency is considering tweaks that would protect rural providers from being negatively affected and may adjust timelines to address concerns about implementation. But he added that hard data, not emotions, would influence any changes.