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  • Washington Highlights

    House Energy and Commerce Holds Hearing on Medicare Part B Drug Payment Model

    Len Marquez, Senior Director, Government Relations

    The House Energy and Commerce Subcommittee on Health May 17 held a hearing on a Centers for Medicare and Medicaid Services’ (CMS) proposed Medicare Part B Drug Payment Model. According to CMS, the proposal would test a new payment model intended to improve value and outcomes, and reduce expenditures for Part B drugs [see Washington Highlights, March 11].

    Currently, Medicare pays for Part B drugs that are administered in a physician’s office or outpatient department, such as cancer medications, at Average Sales Price (ASP) plus 6 percent. During the first phase of the model, CMS would test how prescribing patterns are impacted by changing the payment amount to ASP plus 2.5 percent plus $16.80.

    The AAMC submitted a May 9 comment letter on the proposal specifically highlighting concerns that the proposal would “harm hospitals, physicians, and the patients they serve” [see Washington Highlights, May 13].

    Subcommittee Chair Joe Pitts (R-Pa.) called the proposal “far-reaching” and highlighted concerns regarding the “breadth of the experiment -- essentially across the nation in virtually all primary care service areas; and the timing – these major changes would take place as early as July and on top of the current implementation of MACRA.”

    Ranking Member Frank Pallone (D-N.J.) stressed the importance of innovation in the Medicare program, but noted concerns ensuring that “seniors have access to necessary drugs” and “how the model would be evaluated before it is expanded.”

    Michael Schweitz MD, FACP, MACR, Coalition of State Rheumatology Organizations; Debra Pratt, MD, MPH, MBA, The US Oncology Network, American Society of Clinical Oncology, and Community Oncology Alliance; Marcia Boyle; Immune Deficiency Foundation; Heather Block, Patient Advocate; and Mr. Joe Baker, Medicare Rights Center, provided witness testimony.