Drug Payment Model scrapped; influence of Trump felt?

by: Roy Edroso Dec 16, 2016

Multiple sources report that CMS’ Medicare Part B Drug Payment Model is dead. “After considering comments, CMS will not finalize the Medicare Part B Drug Payment Model during this Administration,” CMS spokesman Aaron Albright is quoted in The Hill.

The rule, proposed on March 8, 2016, was meant to test new ways of paying for Part B drugs under Medicare, including varying the payment for a drug based on its clinical effectiveness for different conditions and working with drug manufacturers to link patient outcomes with price adjustments, to replace the current ASP-plus-6% method. As this would probably have dropped some of the prices the government pays for drugs, pharmaceutical companies were reportedly not in favor.

Maybe they weren’t the only ones: As Part B News has reported (subscription), incoming HHS Secretary Tom Price is not a fan of CMS’ demonstration programs, which he believes exceed the agency’s authority and threaten beneficiary access to care. In its report The Hill suggests Donald Trump’s recent victory has “taken the wind out of some efforts to fight high drug prices:”; Modern Healthcare refers to the CMS Innovation Center, source of this and other CMS demos, as “controversial.”

Watch Part B News for more on this soon.

Blog Tags: CMS, payment models

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