Republicans are balking at the Obama administration’s plan to conduct a series of experiments to steer doctors to prescribe cheaper drugs.
The Centers for Medicare and Medicaid Services announced a proposed rule earlier this week that would create a series of experiments on how Medicare Part B pays for prescription drugs. The goal is to ensure that doctors get the same money for prescribing lower-priced drugs as they do for more expensive ones.
Republicans say that the rule could hinder doctors from prescribing the drugs that their patients need, an assertion the administration flatly rejects.
The administration argues that the new rules can help ensure that a doctor can choose the right drug for their patient. A doctor now can choose among several drugs for treating a patient but get a lower payment from Medicare Part B if they choose a low-cost drug.
Medicare Part B covers doctor visits and pays for prescription drugs administered at a doctor’s office or outpatient facilities, such as chemotherapy and other cancer drugs.
The proposed rule, which needs to be finalized, would test whether incentives will drive doctors to prescribe the most effective drugs, despite what they cost.
The rule drew plaudits from healthcare economic experts.
“CMS is gently trying to move toward a system that pays doctors for doing what they are trained to do, take care of patients, and make the same money whether they use more or less expensive drugs,” said Dr. Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes. “That’s the kind of system that will protect patients who otherwise end up getting more expensive drugs than they need.”
However, leading House and Senate Republicans argued the rule is the latest example of Washington making healthcare decisions for patients.
“The decision was made with a complete lack of transparency and clear disregard for the people and stakeholders who will be impacted the most,” according to a statement from Republican Reps. Fred Upton of Michigan, Kevin Brady of Texas and Sen. Orrin Hatch of Utah. Upton is chairman of the House Energy and Commerce Committee and Brady House Ways and Means, while Hatch runs the Senate Finance Committee.
CMS is holding a comment period on the new rule for the public to weigh in and will issue a final rule after taking into account the comments.
Republicans were worried that the rule could limit access to healthcare for seniors.
“The model could ultimately result in seniors’ receiving different standards of care based solely on where they live in the country,” the statement said.
Rep. Tom Price, R-Ga., added separately that the rule could have a “chilling effect” on patient care.
“It has the potential to seriously disrupt the level of care seniors currently receive, limiting the level of treatments providers may offer despite what a patient’s health conditions demand,” the chairman of the House Budget Committee said.
A senior administration official told the Washington Examiner that the notion the rule will have a “chilling effect” on the ability of providers to help patients is “simply false.”
“The proposed model would reimburse all providers for the cost of every drug plus an add-on payment,” the official said. “So patients will see no threats to access from this model, and could benefit from better care and better value over time.”
Administration officials also said there isn’t any way the proposed models could harm patient access.
“Nothing in this proposed payment model will prevent doctors from prescribing exactly the treatment they think the patient needs,” said Patrick Conway, CMS chief medical officer, during a call with reporters.
