On March 11, the Centers for Medicare and Medicaid Services (CMS) published a new five-year cost-cutting pilot for payment for Medicare Part B drugs, which tend to be injectables or infusion products administered in physician offices or other clinical settings.
Under the pilot, providers would be placed randomly into one of four groups: one that uses the existing model (average sales price of a drug plus 6%) and serves as a control group, and three groups that use new payment models:
- 2.5% add-on payment instead of 6% with a guaranteed $16.80 daily fee regardless of drug price;
- 6% add-on payment with added value-based elements, such as reduced cost-sharing for patients and reimbursement based on a drug's clinical effectiveness; and
- 2.5% add-on payment with the $16.80 daily fee and the value-based elements.
The pilot is slated to take effect in January 2017, but CMS has been inundated with comments which will continue to be accepted until May 9. Oncology and rheumatology physicians, who would be affected the most, have been very vocal in their concerns. In fact, CMS is already considering exempting any practice from the Part B pilot that is currently participating in CMS's Oncology Care Model demonstration. Based on the public concern, it is likely that the pilot models will be revised following the comment period.
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