Patient advocates are joining Republicans in opposing a major proposal from the Obama administration to change Medicare reimbursements to doctors.
The backlash to the Obama administration’s proposal is growing, with more than 300 patient care and advocacy groups across the country slamming it. The move comes as several GOP lawmakers have complained about it.
The Centers for Medicare and Medicaid Services announced a proposal about two weeks ago that would enable the agency to conduct a series of experiments on Medicare Part B payment models. The idea is to get doctors to prescribe more effective, lower-cost drugs and sidestep expensive products. CMS officials have said that the intent is to ensure a doctor can choose the right pharmaceutical for a patient.
A doctor currently gets a lower payment from Medicare Part B if he prescribes a lower-cost drug. For instance, a doctor or hospital gets an additional 6 percent of the average sales price for more expensive drugs.
The agency is concerned that doctors may be prescribing more expensive products to get that additional payment.
Medicare Part B pays for drugs delivered in a doctor’s office or outpatient facility as opposed to a pharmacy. Chemotherapy and cancer drugs are among those affected, which is why several cancer groups are opposing any changes.
Patient and cancer groups believe the experiments could have unintended consequences.
“There are too many assumptions and too few safeguards in the recent proposal to alter the payment rules for Part B drugs,” said Julie Vose, president of the American Society of Clinical Oncology, during testimony before a congressional panel last week. The society advocates for oncologists and receives financial support from several pharmaceutical companies.
Vose said she is worried about whether any effort to revise the oncology payment system will hinder access to treatments for cancer patients.
A group of more than 300 medical groups, which included many cancer centers across the country, echoed the same concern in a letter released last week.
“There is no evidence that the payment changes contemplated by the model will improve quality of care, and may adversely impact those patients that lose access to their most appropriate treatments,” according to the letter sent to congressional leaders in both parties.
The comments come about the same time several GOP lawmakers denounced the experiments.
Rep. Tom Price, R-Ga., said the rule could disrupt the level of care that seniors receive by “limiting the level of treatments providers may offer despite what a patient’s health conditions demand.” Price is chairman of the House Budget Committee.
The administration has pushed back hard against such criticism, saying the proposal won’t prohibit access to treatments for patients.
A few weeks ago it shared comments from several healthcare experts praising the models.
“Part B drug payments are generally not based on value, or on the competitive approaches that have helped bring a value focus to Part D drug payments,” according to a statement from Mark McClellan, a former CMS director under the Bush administration and now with the Brookings Institution.
“While not all of these ideas will work out, testing new Part B drug payment models and finding more effective ways to encourage drug innovation while avoiding unnecessary costs is very important for Medicare,” he added.
The proposed rule is available for public comment until May 9.
