CMS Decides not to Finalize Medicare Part B Drug Payment Policy

Company News | Dec. 23, 2016

On December 15th, CMS announced that the Administration will not implement the proposed Medicare Part B drug payment model. Since being proposed in March 2016, the demonstration was opposed by certain industry groups, and was criticized by Congressional Republicans and some Democrats. Participation in the proposed five-year demonstration would have been mandatory among randomly selected Part B providers and suppliers. The rule proposed to test models that would have:
• Gradually decreased Part B drug payments from 106 percent of the average sales price (ASP) of the drug to 102.5 percent of the ASP, plus a flat fee of $16.80; • Decreased or eliminated beneficiary cost sharing for drugs that are determined to be “high-value”; • Tied the payment of a drug to its effectiveness at treating specific conditions; and • Set standard payment rates for groups of therapeutically similar drugs.
More information on the proposed demonstration is available here