publication date: Mar. 11, 2016

CMS Experiment Targets Incentive to Use the Most Expensive Drug 

Is Average Sales Price plus 6 percent the right amount to pay doctors under the Medicare Part B program?

Would a smaller margin diminish what may be an incentive for doctors to prescribe the most expensive drugs on the market? With clinical performance being equal, or close enough to equal, is it not better for the doctor’s wallet to bill 6 percent of the highest possible ASP available?

In a move that immediately set off an explosion in the cancer field, the Centers for Medicare and Medicaid Services announced a proposed rule to test new models to improve Part B payment for prescription drugs.

According to CMS, the rule, proposed March 8, is designed to test different physician and patient incentives to accomplish two goals: “drive the prescribing of the most effective drugs, and test new payment approaches to reward positive patient outcomes.”

Proponents say that the rule was conceived to save Medicare dollars by addressing rising drug costs, a trend to which physicians may contribute by prescribing more expensive drugs over equally effective—and cheaper—alternatives.

Critics characterized the CMS initiative as a “misguided,” “perilous” and “perverse” policy that threatens viability of oncology practices—a policy change masquerading as an experiment.

“I understand that the way it works for the pharmaceutical industry is … Continue reading 42-10 CMS Experiment Targets Incentive to Use the Most Expensive Drug

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