Rescinded: Changes to the Part B drug payment model

If lately you've been wondering what's been made of a proposed rule that was supposed to change Part B drug payments in the fall of 2016, don't fret about your cognitive state. You didn't suffer a bout of amnesia; the proposal died quietly at some point during the rule-making process and CMS officially cleared it from the books Oct. 3.

 

One can speculate that the incoming administration, which has struck down rules that were far more entrenched, such as joint-replacement bundling, didn't favor the "value-based purchasing tools" that marked the second phase of the proposed drug payment system, which CMS originally introduced back in March 2016.

 

The first phase of the payment reform would have changed the 6% add-on to the average sales price (ASP) to a 2.5% add-on in addition to a flat fee of about $16. Hospitals were expected to be hit with the most lost revenue, though physician practices were thought to be big winners.

 

The Oct. 3 withdrawal doesn't offer many insights into CMS' new way of thinking. "Moving forward, we want to ensure agency flexibility in re-examining these important issues and exploring new options and alternatives with stakeholders as we develop potential payment models that support innovative approaches to improve quality, accessibility, and affordability, reduce Medicare program expenditures, and empower patients and doctors to make decisions about their health care."

 

The withdrawal includes former HHS boss Tom Price's name and title, appearing to show that Price reviewed and signed off on the termination on Aug. 25, ahead of his departure from the agency under controversial details about his use of private jets.

 

Evidently, the 1,300-odd comments that CMS received portrayed a mixed reaction among stakeholders.

 

"Some commenters signaled their support for the proposed rule, however, a number of commenters expressed concerns about the proposed model. As we worked to address these concerns, the complexity of the issues related to the proposed model design and the desire to increase stakeholder input led us to the decision to withdraw the March 11, 2016 proposed rule."