Congress members call on CMS to abandon Medicare drug pilot

More than 240 Congress members penned a letter Monday to CMS Acting Administrator Andy Slavitt outlining six chief concerns with the agency's Medicare "Part B Drug Payment Model" proposed rule.

Concerns over the drug pilot have been stated on both sides of the aisle, though just four Democrats signed the letter, according to coverage in The Hill. Democrats have previously voiced support for adjusting the proposal, but those who wrote the letter called on CMS to scrap the proposal altogether.

The proposed pilot would cap Medicare Part B drug reimbursements. Instead of paying the average price of a drug plus 6 percent, Medicare would pay the average price of a drug plus 2.5 percent and a $16 flat fee.

"CMS's proposed Medicare drug experiment would unnecessarily disrupt care for the sickest seniors who depend on Medicare, including those with cancer, macular degeneration, rheumatoid arthritis, neurological disorders, rare diseases and primary immunodeficiency diseases," the letter reads.

Here are the lawmakers' primary concerns in brief.

1. The cuts could "severely harm patient access to needed drugs," presenting physicians with acquisition costs for certain drugs that are higher than reimbursement levels.

2. The proposal could negatively impact seniors, particularly those who rely on smaller practices or who live in rural areas. According to Congress members, the proposal would require nearly three-quarters of the country to participate.

3. It could lead physicians to refer more patients to hospital outpatient departments, which the lawmakers say are less convenient and more costly than physician practices.

4. The policies were developed without input from outside experts and stakeholders, such as physicians.

5. The Congress members also believe the drug pilot would hinder physicians from participating in new models of care, such as the Oncology Care Model and various alternative payment models incentivized by the new Medicare Access and CHIP Reauthorization Act.

6. Lastly, the lawmakers are concerned the proposal fails to address issues of quality of care and access.


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