Republican Senators: Medicare Should Pull Drug Rule

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By Michael D. Williamson

April 28 — Senate Finance Committee Republicans April 28 called on the CMS to pull a Medicare Part B proposed drug payment rule that the lawmakers said in a letter would disrupt care for vulnerable patients.

Democrats on the Finance Committee also took issue with the proposal in an April 27 letter. However, they didn't go as far as to call for the CMS to pull the rule.

The lawmakers' letters represent the latest in a string of concerns expressed over the proposed rule, which covers Part B drugs, such as cancer medications, that are administered in a doctor's office or hospital outpatient department.

The proposed payment model (81 Fed. Reg. 13,229), released March 11 (46 HCDR, 3/9/16), would test new ways to support physicians and other clinicians “as they choose the drug that is right for their patients,” the Centers for Medicare & Medicaid Services said at the time.

In their letter to the agency, Finance ranking member Ron Wyden (D-Ore.) and other Democrats on the committee asked the CMS to work with affected parties before going forward with a final rule.

Patients, providers and other stakeholders have raised numerous concerns about the model's potential to have unintended consequences on Medicare beneficiaries' access to care and to physician-administered drugs, Wyden and his Democratic committee colleagues said.

Furthermore, the proposed payment model would require health-care providers across the nation to engage in drastic changes in payment procedures, Finance Chairman Orrin Hatch (R-Utah) and other committee Republicans told the CMS in their letter.

Specifics

For example, a proposed average sales price (ASP) payment reduction in the rule would harm access to “vital drugs” because many providers would face prescription costs that exceed the new Medicare payment amount offered under the model, the Republican lawmakers said.

This problem would be especially acute for small physician practices and practices in rural areas, Hatch and his colleagues said. Doctors who have trouble accessing drugs with the reduced ASP payment would likely refer patients to hospital outpatient departments, which are a less-convenient and more costly setting, they added.

Overall, the ASP proposal would limit beneficiaries' choice, increase costs and could further hospital acquisitions of physician practices, the Republicans said.

The letter from Finance Democrats also outlined concerns about reducing ASP and how doing so would affect drug access and push beneficiaries to more costly hospital outpatient department.

Reaction

A group representing community oncology practices, the Community Oncology Alliance, praised the letters.

“It is encouraging to see that Congress is beginning to see what a disaster the Medicare Part B experiment will be for seniors and their providers,” Ted Okon, the group's executive director, said in an April 28 statement provided to Bloomberg BNA.

The recent letters from both the Republican and Democratic members on the Finance Committee “leave us hopeful that this misguided proposal will be rejected outright,” Okon said. Nothing short of a full withdrawal would be enough, he said.

Okon also called the proposed rule a “dangerous experiment” because beneficiaries couldn't opt out of the model.

A drug industry group also applauded efforts to quash the rule.

The Pharmaceutical Research and Manufacturers of America (PhRMA) is strongly opposed to the proposed Medicare Part B payment changes, and it supports withdrawing the proposal, Allyson Funk, a spokeswoman for the association, told Bloomberg BNA April 28.

“[W]e expressed grave concern about the consequences of this proposal” and joined with more than 300 other patient and provider groups to express displeasure with this rule, Funk said.

Shortly after the CMS published the rule, 317 regional and national medical groups, including PhRMA, asked Congress to prevail upon the CMS to permanently withdraw the proposal (54 HCDR, 3/21/16).

Comments (CMS-1670-P) on the rule are due May 9.

To contact the reporter on this story: Michael D. Williamson in Washington at mwilliamson@bna.com

To contact the editor responsible for this story: Brent Bierman at bbierman@bna.com

For More Information

The letter from Senate Finance Republicans is at http://src.bna.com/eu3.

The letter from Senate Finance Democrats is at http://src.bna.com/eu5 .