Proposed rule rolls out 6 potential Part B drug pay models

by: Julia Kyles, CPC Mar 8, 2016

By the end of the year, your practice or outpatient department could be taking part in a test of a new Part B drug payment model.

CMS today released a proposed rule, that would cover most Part B drugs. The test of the different proposed models would be more intense that other payment demonstrations because participation would be mandatory for providers in the geographic areas CMS selects.

CMS is considering six different approaches to payment for Part B drugs:

Change the add-on payment to 2.5% plus a flat fee payment of $16.80 per drug per day.
Discount or eliminate patient cost-sharing.
Provide clinical decision support tools that inform prescribers about safe and appropriate use of selected drugs.
Vary the payment for a drug based on its clinical effectiveness for different conditions.
Set standard payment rates for a group of therapeutically similar drug products.
Work with drug manufacturers to link patient outcomes with price adjustments.

A change to the average sales price model has been on CMS' wish list for a while; drug costs have long made up a huge chunk of Medicare's expenses. During a press call that took place shortly before the proposed rule dropped, Patrick Conway, M.D., CMS deputy administrator for innovation and quality and chief medical officer reiterated a statement by MedPAC to the effect that the 6% add-on model could create incentives to use higher priced drugs.

Conway also noted that CMS has heard from doctors who say they feel pressured to use higher priced drugs even when that isn't the most appropriate treatment for a patient and emphasized that the new payment models would not interfere with clinician decision making.

Comments for the rule are due May 9, watch upcoming issues of Part B News for more information.

Blog Tags: health care reform, proposed rules

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