Medicare Part B Drug Prescribing Model Benefits Beneficiaries
Medicare Rights Center President Joe Baker spoke in front of CMS and testified his organization’s support of the Medicare Part B drug prescribing reforms.
By - There has been a fair amount of controversy regarding Medicare Part B drug prescribing reforms. For instance, the Community Oncology Alliance (COA) has called for blocking the regulation changing Medicare Part B drug prescribing practices. The American Medical Group Association (AMGA) also sent its concerns to the Centers for Medicare & Medicaid Services (CMS) regarding the new ruling.
However, Medicare Rights Center President Joe Baker spoke in front of CMS and testified his organization’s support of the Medicare Part B drug prescribing reforms, according to a press release. In particular, Baker mentioned how the new regulation would benefit Medicare beneficiaries’ access to prescription medication.
“Calls to withdraw the Part B Drug Payment Model fail to acknowledge the very real and unrelenting beneficiary access challenges that exist under the current payment system—not merely hypothetical ones. We applaud CMS for proposing to test solutions that have the potential to alleviate calamitous cost burdens, which cause too many older adults and people with disabilities to forgo necessary care,” Joe Baker stated in front of CMS. “We urge members of Congress to support and strengthen the proposal by recommending improvements that put patients at the center of the payment model.”
The Medicare Rights Center has worked with families and Medicare beneficiaries for more than 20 years and has the knowledge that stimulated their support of the new Medicare Part B drug prescribing regulations. This organization helps more than two million Medicare beneficiaries, professionals, and caregivers every year.
“As President of the Medicare Rights Center, I lead a national nonprofit organization that works to ensure access to affordable healthcare for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives,” Baker continued.
“The Medicare Rights Center supports the proposed model. The model seeks to realign perverse payment incentives while ensuring that healthcare providers continue to prescribe the medications best suited to the individual needs of patients. The model also brings innovative, value-based payment strategies being used in the private market to the Medicare program.”
A common theme that comes from its helpline is the typical caller’s difficulty affording necessary healthcare services. The Medicare Rights Center believes that the new regulation will help the everyday patient cover their medical costs and prescription drug prices.
Cost-sharing related to Part B drugs can be increasingly high especially for cancer or immunosuppressive drugs, which is a major problem for older adults living on a fixed income. The Medicare Rights Center believes that these new regulations will make an impact on reducing the spending related to prescription drugs.
“This objective will not be realized if pursued only in siloes meaning that prescription drugs including Part B medications must be part of these reforms,” Baker explained. “Beyond improving the quality of care delivered to beneficiaries, the proposed model may help the Medicare program by promoting more efficient use of program funds. Last year, Medicare spent $22 billion on prescription drugs.”
“Challenges affording needed healthcare are a common theme heard on our helpline,” he continued. “Many of these cases involve beneficiaries with original Medicare who lack adequate supplemental coverage.”
“Estimates suggest that between 10 to 14 percent of beneficiaries only have original Medicare, making them responsible for 20 percent of coinsurance on all Part B services with no out-of-pocket maximum. These beneficiaries can be exposed to catastrophic costs, which can reach as high as over $100,000.”
“Calls to withdraw the Part B payment model fail to acknowledge the very real and unrelenting beneficiary access challenges that exist under the current model, not merely hypothetical ones. We commend the Centers for Medicare & Medicaid Services for proposing to test solutions that have the potential to alleviate calamitous cost burdens, which cause too many older adults and people with disabilities to forego care.”
“We urge members of Congress to support and strengthen the proposal. The Medicare Rights Center engaged in this very process. Our comments on the model focus on the need for enhanced monitoring and oversight. Among the topics we addressed were concerns raised about how the model might shift how care is provided such as from community practices to hospital settings.”
The Medicare Rights Center sent comments to CMS about the Part B drug prescribing model in early May. One key point the comments mentioned was the need for monitoring beneficiaries’ experience with the new model for drug prescribing.
“CMS should create robust feedback loops to monitor beneficiaries’ experiences throughout the proposed model and to respond in real time to potential problems,” the comment letter stated. “We understand that CMS expects to draw on the agency’s monitoring experience with the DMEPOS competitive bidding program for the Part B Drug Payment Model, namely through timely claims review. We strongly encourage CMS to take this further by creating a dedicated ombudsman for the Part B Drug Payment Model.”
“In addition to establishing a dedicated ombudsman, we encourage CMS to identify formal processes for regularly engaging and involving Medicare beneficiaries and the organizations that represent them as the agency carries out the proposed model."
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