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CMS Halts on Changing Medicare Part B Prescription Guidelines

Due to stakeholder input, CMS decided not to pursue finalizing a rule that would change drug prescription payment under Medicare Part B.

By Vera Gruessner

The American Hospital Association (AHA) reported on December 16 that a finalized rule for the prior proposal to test new models for prescription drug payments under Medicare Part B has been scrapped. The Centers for Medicare & Medicaid Services (CMS) considered comments from stakeholders and decided to not pursue the changes to prescription drug payments under Medicare Part B.

Medicare Part B Drug Payment Model

While the proposal was meant to reduce the costs associated with continually rising prescription drugs and many stakeholders including AHA support the idea of cutting these costs, the potential changes the model would cause on prescribing habits of physicians and hospital staff brought concerns.

“After considering comments, CMS will not finalize the Medicare Part B Drug Payment Model during this Administration,” a CMS spokesperson told the American Hospital Association News. “The proposal was intended to test whether alternative drug payment structures would improve the quality of patient care and the value of Medicare drug spending. While there was a great deal of support from some, a number of stakeholders expressed strong concerns about the Model.”

“The complexity of the issues and the limited time available led to the decision not to finalize the rule at this time,” the CMS spokesperson said.

One example of a stakeholder that opposed these changes to Medicare Part B comes from the Community Oncology Alliance (COA). The organization claimed that the proposed rule could harm patient safety by changing the way physicians and oncologists assign prescription drugs. The argument involves the transformation in clinical decision-making the proposal would create without a strong understanding of medication prescription methods in the oncology space.

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On the other side of the argument, Medicare Rights Center President Joe Baker testified in front of CMS earlier this year on behalf of his organization’s support for the proposed changes to Medicare Part B drug prescribing. Baker claimed that the new proposal would help Medicare beneficiaries gain greater access to prescribed medicine.

In particular, the high costs associated with prescription drugs make it more difficult for seniors to afford out-of-pocket costs for their medication. Baker explained that the new CMS models for Medicare Part B drug prescription would reduce these burdens. Baker continued to describe that the payment model would bring payment incentives that required doctors to assign medication based on “the individual needs of patients.”

Democratic Leader Nancy Pelosi stated publically that, while the decision to not proceed with the proposed rule is for the best, the continually rising cost of prescription drugs needs to be addressed in a bipartisan manner.

“While the proposed Medicare Part B demonstration had admirable goals, our Members raised a number of concerns, and we are pleased the Center for Medicare and Medicaid Innovation has decided not to move forward,” Pelosi said. “Prescription drug costs represent the largest factor driving rising health care costs in America today. Congress must come together in a bipartisan way to address the soaring costs of prescription drugs in a way that supports the search for cures while ensuring that patients can afford these treatments.”

The American College of Rheumatology also supports the decision to not proceed with changes to Medicare Part B drug prescribing, according to a press release. The problems for the American College of Rheumatology involve the lack of more affordable and clinically equivalent prescribed medication available for Medicare beneficiaries managing rheumatic diseases along with the risks to patient safety associated with switching to less effective therapies.

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“We thank CMS for listening to the rheumatology community’s concerns about the negative and disproportionate impact this proposal would have on our Medicare patients living with rheumatic diseases by not moving forward with this Part B Demonstration Project,” said Dr. Sharad Lakhanpal, MBBS, MD, President of the ACR. “For older Americans living with painful and debilitating diseases like rheumatoid arthritis, lupus, spondyloarthritis, and psoriatic arthritis, safe access to biologic therapies is not an option but a necessity - which is why the ACR has been vocal in expressing our concerns about the unintended consequences of this proposal and its flawed cost-savings premise.”

“This positive outcome will help ensure Medicare beneficiaries living with rheumatic diseases are able to continue receiving the therapies they need to manage their chronic conditions and avoid pain and disability.”

The American Medical Group Association (AMGA) was also satisfied with the CMS decision to pull back from finalizing the proposed rule changing drug prescription guidelines for Medicare Part B.

“AMGA appreciates that the administration considered stakeholder feedback from AMGA and others and will not move forward with this proposal,” Donald W. Fisher, Ph.D., CAE, AMGA’s President and Chief Executive Officer, said in a public statement. “AMGA supports the transition to value-based payment and looks forward to working with the current and incoming administration on building a healthcare system that truly rewards quality of care, reduces cost, and advances population health.”


READ MORE: Prescription Drugs Account for 22% of Payer Premium Spending

Dig Deeper:

Medicare Part B Drug Prescribing Model Benefits Beneficiaries

Is the Medicare Part B Proposed Rule ‘Bad Medicine’?


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