CMS Announces End to Medicare Part B Drug Payment Model
Published on: December 20, 2016
On December 15, 2016, the Centers for Medicare and Medicaid
Services (CMS) announced the cancellation of Medicare Part B Drug Payment
Model. CMS initially proposed the demonstration on March 8, 2016 to test
new models in how physician-administered drugs are paid under the Medicare
In May 2016, ASH submitted comments on
the proposed rule expressing concern that the demonstration could create
barriers to access to important and life-saving drugs. Under the
proposal, CMS would have adjusted the payment rate for individual drugs in the
hopes to incentivize selection based on performance rather than price.
However, ASH stressed that for hematology, there is often no choice in
chemotherapeutic agents, and consequently, a change in the payment rate for
individual drugs could make providing certain drugs more difficult for
physician practices and hospitals.
the beginning, the proposed model was controversial, and received pushback from
medical specialty societies, cancer groups, pharmaceutical companies and
hospital organizations, among others. CMS indicated that the cancellation
was in large part a result of the 1,300 public comments received, most of which
were negative. ASH will continue to support innovation in delivery and
payment models to help reduce the burden of the overall cost of medical care
and particularly, the high cost of drugs, without compromising access to care.
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