publication date: May. 20, 2016

Capitol Hill

House Committee Provides Forum for Opponents of Part B Payment Model 


A Congressional committee earlier this week provided a venue for opponents of a controversial Medicare Part B payment model to argue against its implementation by Centers for Medicaid Services.

Witnesses at the May 17 hearing of the health subcommittee of the House Committee on Energy and Commerce said the payment model would make it difficult for Medicare patients to obtain care, and one witness likened the model to an unethical clinical trial. Also, in what couldn’t be a coincidence, two witnesses—representing patients with immune deficiencies and rheumatology—submitted written testimony that contained identical paragraphs.

The hearing was linked to a bill introduced earlier this month by Reps. Larry Bucshon (R-Ind.) and Robert Dold (R-Ill.), which effectively consists of one sentence: “The Secretary of Health and Human Services may not take any action to finalize, implement, or enforce the proposed rule entitled ‘Medicare Program; Part B Drug Payment Model.’”

The agency’s stated goal for tweaking the ASP-based reimbursement formula is to learn whether it currently gives physicians the incentive to prescribe the most expensive treatments available (The Cancer Letter, May 13, March 11).

The first phase of the proposal would change the Part B prescription drug reimbursement rate from Average Sales Price plus 6 percent—among providers selected randomly by primary care service area—to ASP plus 2.5 percent, plus $16.80 per drug per day administered. … Continue reading 42-20 House Committee Provides Forum for Opponents of Part B Payment Model

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