More than half of the House membership is demanding the Obama administration halt an experiment that would alter how it reimburses doctors for needed drugs.
The bipartisan collection of 242 lawmakers said in a letter to the administration that the proposal could hamper access to needed drugs for cancer, macular degeneration and rheumatoid arthritis. Administration officials said the proposal is meant to help drive down high drug costs.
GOP lawmakers spearheading the letter said the effort would allow government too much power on what care should be given to patients.
“It takes clinical decision-making out of the hands of physicians and patients,” said Rep. Tom Price, R-Ga., head of the House Budget Committee. “Through this one-size-fits-all approach, the administration will sway treatment options based solely on the cost and not on the patient’s individual clinical needs.”
The proposal affects drugs that are reimbursed under Medicare Part B, which covers doctor visits and drugs that are administered in doctor or other healthcare settings. Such drugs include chemotherapy for cancer patients.
The idea behind the experiment is to end an incentive for doctors to prescribe higher-priced drugs. Doctors get reimbursed for the cost of the drugs, plus 6 percent of the average sales price.
The proposal instead would give doctors 2 percent plus a small $16 fee per day per drug.
Republicans and some Democrats are fighting the proposal.
Experts and administration officials counter that by taking away the incentive for doling out pricey drugs, doctors instead will pursue cheaper drugs that provide the same value.
“All the research shows that prescribing patterns and hospital purchases of doctors’ offices are heavily influenced by the proportional profits model of drug reimbursement,” said Peter Bach, a doctor at Memorial Sloan Kettering, in a statement provided by administration officials.
The Washington Post editorial board wrote on May 1 that the current model contributes to the high drug prices facing the American healthcare system.
“Medicare rules do, indeed, encourage physicians to use more expensive drugs instead of cheaper equivalents, and the incentive is strongest with a relative handful of highly expensive cancer drugs,” the editorial said.
