CMS Chief Medical Officer Dr. Patrick Conway on Tuesday defended a controversial proposal for changing Medicare reimbursement for outpatient drugs to lawmakers mostly hostile to the idea.
Members of the Senate Finance Committee called the proposal an “ill-conceived experiment” that would limit beneficiary access to medications, especially in rural areas and at small practices.
Senators repeatedly grilled Conway about whether CMS would withdraw or change the proposal. He continued to reply that CMS is carefully looking at all the comments it received with a particular eye toward concerns about reduced patient access to drugs.
The plan calls for lowering Medicare Part B payment to doctors from 6% to 2.5% in addition to a drug's average sales price and adding a payment of $16.80 per drug per day. The proposed rule received more than 1,300 comments and has met strong opposition from lawmakers as well as doctor and patient groups.
They say the change could put some drugs out of the reach of patients, particularly at small practices in rural areas that wouldn't receive enough reimbursement to cover the cost of the drug. The proposal has also been criticized for failing to address the core issues surrounding high prescription drug prices.
On Tuesday, Conway said the proposal is an attempt to rein in rising drug costs by eliminating a disincentive for doctors to prescribe less expensive drugs.
The new model is part of CMS' dedication to moving toward value-based payment reform and has a second phase that would include a menu of value-based purchasing options that commercial health plans and pharmacy benefit managers have used, he said.
The CMS has noted the concern for small and rural practices and has proposed a monitoring plan and potential exceptions to the rule, Conway said.
He added that he is contacted daily by beneficiaries who currently have problems affording drugs prescribed to them.
“If we think the status quo is optimal, I think we are mistaken, and we need to test new models,” he said.
A recent report from the Medicare Payment Advisory Commission argued that “there may be room for a reduction to the add-on portion of the payment rates for Part B drugs, which could create savings for the Medicare program.”
Sen. Pat Roberts (R-Kan.) said the CMS should withdraw the proposal because it amounts to rationing and will disrupt care to the most vulnerable patients. Democrats and Republicans have written to the CMS requesting withdrawal or delay of the rule, along with the American Medical Association, the Medical Group Management Association and the Community Oncology Alliance.
