AACU News & Notes

AACU Joins Coalition to Oppose Harmful Medicare Part B Payment Changes

posted: April 3, 2017

On April 3, the AACU joined over 180 organizations in a letter to the Medicare Payment Advisory Commission (MedPAC) expressing concern over the harmful changes to Medicare Part B currently under consideration.

In all, the AACU stands with physicians, patients, and health care providers and urge the Commission to reconsider these changes that could threaten access to quality care under Medicare Part B.

Proposed Changes to Medicare Part B Payments

Medicare Part B provides coverage for infusion and injection therapies that are critical for patients afflicted with serious conditions, including bladder cancer and prostate cancer. Patients and providers who treat these types of conditions face significant challenges as patients frequently must try a multitude of medication therapies before finding the one that works for them. Medicare Part B currently ensures that patients have access to infusion and injection therapies typically administered by physicians in an office or hospital outpatient setting.

MedPAC, an independent panel tasked with advising Congress and regional program administrators on Medicare payments, is considering whether to recommend systemic changes to the Part B drug reimbursement process. Regardless of whether they occur through changes to the payment rate or billing codes, reductions in Part B payments would ultimately make it more difficult for providers to offer certain therapies due to cost constraints. In all, the proposed MedPAC recommendations could infringe on the patient-doctor relationship by restricting the doctor’s ability to provide access to appropriate and effective care.

Letter to MedPAC Opposing Proposed Changes

The AACU joined over 180 organizations in signing a letter urging the Commission to reconsider the harmful proposed changes to Medicare Part B. The letter touched on the following points:

  • We are concerned that the changes to Medicare Part B under consideration could restrict the ability of physicians to provide medications typically administered at their offices to treat patients with serious conditions such as bladder cancer and prostate cancer. These patients are already among the sickest and most vulnerable patients in the Medicare program and are in critical need of immediate access to the right medication, which is made even more complicated by the fact that treatment plans may change on a frequent basis.
  • By ensuring patients have access to a wide array of infusion and injection treatments, Medicare Part B currently allows patients and their physicians to decide which treatments are best. The proposals being considered by MedPAC, however, would infringe on the patient-doctor relationship by making it more difficult for physicians to offer certain therapies due to increased cost constraints.
  • Some particular concerns regarding certain specific proposals include:
    • Some physicians, particularly those in small or rural practices, would no longer be able to provide certain medicines if Part B payments are reduced.
    • MedPAC’s proposal to blend coding and reimbursement for biologics or therapeutically similar treatments will make it more difficult to track and analyze adverse events, with could compromise patient safety. And even further, CMS is not in a position to appropriately determine which drugs are therapeutically similar for blending purposes; this complicated determination should be left up to physicians.
    • MedPAC’s proposal to blend coding and reimbursement for Part B medications or establish arbitrary reimbursement caps through an inflation limit could greatly limit innovation in the next generation of Part B treatments, including biosimilars, which are expected to generate savings for the Medicare program.
    • MedPAC’s proposal to create a new “Drug Value Program” contains a number of critical gaps, which if left could impede patient access to care by imposing new restrictions on Part B medications.

Additional Resources

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