The Digestive Health Physicians Association (DHPA) submitted formal comments to the Centers for Medicare & Medicaid Services (CMS) opposing the proposed Medicare Part B rule. Consistent with a letter from over 240 members of the U.S. House of Representatives, DHPA urged CMS to withdraw the proposed rule, raising the following concerns:
- The proposed policy prescribes significant shifts in reimbursement with no consideration for the clinical utility or the available alternatives to any Part B medication. Of particular concern to our patients, it will become significantly more difficult for physician practices to afford Remicade, which is a therapy of last resort with no clinical alternatives for physicians to administer for certain inflammatory bowel diseases.
- At the same time that reimbursement will be cut for drugs like Remicade, less clinically useful drugs will be reimbursed at far greater rates—apparently for the sole purpose of ensuring budget neutrality. Thus, CMS’s proposed pricing structure runs counter to the clinical utility of the particular drugs at issue.
- CMS has not established that this major change in payment policy falls under the authority of the Center for Medicare and Medicaid Innovation to test models addressing a “defined population experiencing deficits of care.” Such a limitation is mandated by statute and is critical to ensuring that CMS not exceed its already broad waiver authority.
Click here to read the full comment letter.