The Digestive Health Physicians Association (DHPA) has joined a coalition of more than 300 leading patient, disease and provider organizations in sending a letter to congressional leadership requesting that they ask the Centers for Medicare & Medicaid Services (CMS) to permanently withdraw its proposed rule that would implement a new “Medicare Part B Payment Model.”
On March 8th, CMS announced a proposed rule designed to implement a new two-phase “Medicare Part B Payment Model.” The proposal seeks to test alternative drug payment designs in an effort to reduce spending. Specifically, the first phase of the proposal, beginning in late 2016, would reduce Part B drug reimbursement from the ASP+6 percent model to ASP+2.5 percent with an additional add-on payment of $16.80 per drug/per day. Then in 2017, CMS intends to begin testing new value-based purchasing options. There is a 60 day comment period for this proposed rule, ending on May 9th. DHPA intends to submit formal comments to CMS on this proposal.
The letter to congressional leadership brought to light the fact that an initiative focused on costs rather than patients and healthcare quality, and implemented based on primary care service areas rather than the unique challenges facing patients, is misguided and ill-considered. It also pointed out that data show the current Part B drug payment system has been cost effective and successful in ensuring patient access to their most appropriate treatment, as expenditures have remained relatively stable and Part B drugs account for just 3 percent of total program costs.
The coalition further expressed concern that CMS did not receive sufficient stakeholder input and that implementation of the new model will, “adversely affect the care and treatment of Medicare patients with complex conditions, such as cancer, macular degeneration, hypertension, rheumatoid arthritis, Crohn’s disease and ulcerative colitis, and primary immunodeficiency diseases.”
Medicare beneficiaries, some of the nation’s oldest and sickest patients, must often try multiple medications before finding the appropriate treatment for complex conditions. Requiring patients and the providers who care for them to participate in this initiative may force them to switch from the most appropriate medication – further complicating already complex care and treatment options.
At DHPA’s request, the coalition agreed to include Crohn’s disease and ulcerative colitis to the list of conditions that will be adversely impacted by this proposed rule. Within the coalition, GI physicians and patients they care for were represented by numerous state-based associations, two national organizations, DHPA and the American Gastroenterological Association (AGA), as well as a number of disease specific advocacy organizations, including the Colon Cancer Alliance, the Global Colon Cancer Association and others.
Click here to read the full letter to congressional leadership.