Healthcare, patient groups speak out against Medicare Part B proposal

Over 300 healthcare and patient advocacy organizations sent a letter to Senate and House leaders on Thursday urging them to press the Centers for Medicare and Medicaid Services to permanently withdraw a reduced Part B drug payment model from consideration.

CMS has proposed testing the new model, recommended by the Medicare Payment Advisory Commission, to lower the 6 percent add-on payment to Part B prescription drugs to 2.5 percent and to include a flat fee of $16.80 per drug per day.

The move is seen as a way to counter the rising costs of prescription drugs.

In the proposed rule, CMS expresses concern that the 6 percent average sales price add-on payment may encourage the use of more expensive drugs because they generate more revenue.

Opponents have said the rule would adversely affect beneficiaries, push cancer care delivery into the more expensive hospital setting, result in drug reimbursement below the average sales price, and is based on the faulty assumption that oncologists practice medicine solely by financial incentives.

Medicare Part B covers drugs administered in a physician's office or hospital outpatient department, such as cancer medications, injectables like antibiotics, or eye care treatments.

[Also: Opponents of CMS Medicare Part B proposal call plan 'perverse' and 'dangerous']

Part B expenditures remain relatively stable and Part B drugs account for just 3 percent of total program costs, according to Thursday's letter from 316 physician groups and other organizations nationwide.

More than 60 signers sent a similar letter earlier this month to Department of Health and Human Services Secretary Sylvia Burwell.

Medicare patients with cancer, macular degeneration and other complex conditions must often try multiple prescription drugs and/or biologics before finding the appropriate treatment, the organizations said in the letter.

" … They should not face mandatory participation in an initiative that may force them to switch from their most appropriate treatment," the letter states. "Medicare beneficiaries with life-threatening and/or disabling conditions would be forced to navigate a CMS initiative that could potentially lead to an abrupt halt in their treatment."

The signers also said they were disappointed that CMS only provided a limited opportunity for stakeholders to give input before announcing the sweeping proposed changes to Medicare Part B drug payments.

Since the Centers for Medicare and Medicaid Innovation is statutorily required to ensure initiatives target deficits in care, it is unclear what CMS is attempting to address given the success of the current Part B reimbursement methodology, the letter said.

"We believe these types of initiatives should be initially implemented in a targeted, patient-centered and transparent way that accounts for the unique needs of Medicare beneficiaries," the organizations said. "We are very deeply concerned, therefore, that CMS' proposed Part B Model would be applied on a nationwide basis – to all states except Maryland, due to its all-payer model – and would include the 'majority' of Part B drugs."

[Also: CMS releases dashboard for Part D, Part B drug spending; See amounts for top 80 drugs]

Under the Budget Control Act, CMS has already cut Medicare reimbursement for physician-administered drugs by 2 percent, which affects some providers' ability to administer drugs at the current reimbursement rate, according to the letter.

"We therefore request that you ask CMS to permanently withdraw the Part B Drug Payment Model from consideration," they said.

The letter was sent to Senate Majority Leader Mitch McConnell, Senate Minority Leader Harry Reid, Speaker of the House Paul Ryan, and House Minority Leader Nancy Pelosi.

Twitter: @SusanJMorse