Advocacy Groups Urge MedPAC to Reconsider Medicare Part B Proposal

April 18, 2017

ASCO recently joined more than 180 patient and provider advocacy groups in signing a letter to the Medicare Payment Advisory Commission (MedPAC), urging the congressional advisory group to reconsider proposed changes to Medicare Part B drug reimbursement.

In its March Public Meeting, MedPAC unanimously supported recommendations that would fundamentally restructure reimbursement for Part B drugs. For example, instead of the current Average Sales Price plus 6 percent reimbursement formula, the MedPAC proposal would have drug companies pay a rebate to Medicare when the average sales price of their products increases faster than an inflation benchmark.

MedPAC also proposed a “drug value program” that would create a negotiation system for physician-administered drugs. Under this program, a limited number of vendors would negotiate drug prices, and participating providers would buy those medicines at the vendor-negotiated prices, which prices that would not be made public.

Concerns expressed in the letter include:

  • Some providers, particularly those in small or rural practices, would not be able to provide certain drugs if reimbursements are reduced or blended through consolidated billing codes.
  • Patient safety could be compromised if proposals to blend coding and reimbursement for biologics or therapeutically similar treatments go forward because it will be more difficult to track and attribute adverse events.
  • Proposals to blend coding and reimbursement for similar Part B drugs or to establish arbitrary reimbursement caps through an inflation limit could stifle innovation in the next generation of Part B treatments—innovations which may generate savings for beneficiaries and the Medicare program.
  • The “drug value program” proposal leaves a number of critical questions unanswered, and as proposed could harm patient access by imposing new restrictions on Part B therapies.

Read the full letter, and keep an eye on ASCO in Action for the latest cancer policy news and updates on Medicare physician reimbursement.