Below are five findings from Avalere on physician reimbursement under new Medicare Part B payment models.
1. Payment changes for physician-administered drugs would reduce reimbursement to physicians for those drugs that cost more than $480 per day in 2016.
2. Drugs that cost physicians less than $480 a day would result in payments to physicians that are higher than the payments they get today.
3. Seven of the 10 drugs that will incur the largest reduction in reimbursement under the new payment models are used to treat cancer.
4. As a result, those physicians that most often use higher-cost drugs, such as ophthalmologists, oncologists and rheumatologists, would experience the most noticeable reduction in payments. Primary care physicians, who tend to use lower-cost drugs, would see reimbursement increase.
5. More than 50 percent of the payment reductions come from 10 drugs, which would experience a cumulative reduction in Medicare reimbursement of about $252 million within the first year if changes were implemented nationally. In 2014, more than 1 million Medicare beneficiaries were treated with at least one of these 10 drugs.
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