Congressional Panelists Urge CMS to Withdraw Part B Proposal

May 19, 2016

Physicians on a congressional panel Tuesday called for the Centers for Medicare and Medicaid Services to withdraw their Part B demonstration proposal. Panelists cited patient access concerns and lamented CMS’ complete lack of “pre-rulemaking dialogue” with stakeholders.

The panel, “The Obama Administration’s Medicare Drug Experiment: The Patient and Doctor Perspective,” explored how CMS’ two-phased plan to reduce Part B drug costs could impact patient care. It was held by the House Energy and Commerce Committee’s Health Subcommittee.

The proposed demonstration would first reduce physicians’ reimbursement and then test new payment models on clinicians who administer Part B drugs. Participation would be mandatory for physicians in randomly selected zip codes.

Impact on Patients

The panel’s two physicians described patient access issues as a primary concern. As reimbursement dips below the cost of storing and administering Part B drugs, physicians may offer fewer of them. Panelist Michael Schweitz, MD, pointed out that sequestration has already reduced physicians’ reimbursement for these infused and injectable drugs –from six percent of the average list price down to 4.4 percent.

Dr. Schweitz and fellow panelist Debra Patt, MD, explained that the cost burden would lead physicians to send more patients to the hospital to receive their Part B drugs. And that could hurt patients, especially those in rural communities. Seniors could see their co-pays rise, further complicated by the cost and logistical challenges of traveling to and from the hospital.

Rep. Fred Upton (R-MI), committee chairman, described his own concerns about patient impact in a written statement, explaining, “We are talking about our moms and dads, grandparents, friends, neighbors, and our Greatest Generation – and the government wants to experiment with their care.“

Cost and Cost-Sharing

Access concerns are nothing new for many of these patients, explained patient advocate Heather Block. Ms. Block, who has breast cancer, noted that her co-pay for Part B drugs was 20 percent with no out-of-pocket maximum. She described creating and updating budgets to try and deal with her financial bind. One segment of the demonstration would explore reduced or eliminated patient cost-sharing, Ms. Block pointed out, adding “I hope my zip code gets picked [for that portion of the demonstration].”

Joe Baker of the Medicare Rights Center defended the demonstration project and reiterated widespread concerns about high drug costs. Dr. Patt noted that some clinics were already working to lower costs by using value pathways, which encourage the use of low-cost treatments.

A Better Way

Multiple panelists complained of CMS’ lack of stakeholder engagement prior to releasing the proposed rule. With the oncology care model, Dr. Patt explained, CMS had considered input from physicians and stakeholders for a period of three years. Dr. Patt, Dr. Schweitz and Marcia Boyle of the Immune Deficiency Foundation each urged CMS to withdraw the proposal and begin again.

The proposal has also spurred congressional action. Rep. Larry Buschon (R-IN) introduced a bill in April to prohibit further action on the proposed project. The bill has been referred to the House Energy and Commerce Committee and the House Ways and Means Committee.

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