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Price, Shimkus, Boustany Lead Bipartisan Letter to Prevent Administration’s Medicare Experiment

May 02, 2016

WASHINGTON, D.C. – House Ways and Means Committee Member and Budget Committee Chairman Tom Price, M.D. (R-GA), House Energy and Commerce Committee Member John Shimkus (R-IL), and House Ways and Means Committee Member Charles Boustany Jr, M.D. (R-LA) spearheaded a letter sent today demanding Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt to withdraw the Administration’s proposed Part B Drug Payment Model.

On March 8, 2016, CMS released a proposed rule modifying its reimbursement rate for Medicare Part B drugs. The new model is a mandatory demonstration project developed by the Center for Medicare & Medicaid Innovation (CMMI) that would be conducted across nearly all Primary Care Service Areas in the United States. While sending the letter, Congressmen Price, Shimkus, and Boustany spoke out against the proposal:

“CMS’s proposed Medicare Part B Drug Payment Model gives government bureaucrats the power to experiment with the lives of vulnerable seniors and the nation’s sickest patients,” said Congressman Price, M.D. “It creates disincentives for treating patients who depend on Medicare, including those with cancer, rheumatoid arthritis, rare diseases, and neurological disorders. In addition, it takes clinical decision-making out of the hands of physicians and patients. Through this one-size-fits-all approach, the administration will sway treatment options based solely on cost and not on the patient’s individual clinical needs. We must get Washington out of the way and fight to protect access to essential drugs for those whose lives are at stake. Thus, we again urge CMS to withdraw the proposed Medicare Part B Drug Payment Model.”

“This experiment threatens a critical community cancer clinic in my district,” said Congressman Shimkus. “If that clinic in Harrisburg is closed, patients would be forced to travel well over 100 miles to receive treatment. That is unacceptable. Major changes to Medicare should be made only after appropriate and necessary input from relevant stakeholders, including patients, providers and Congress.”

“As a doctor I know firsthand how drug costs are rising, restricting access for seniors. Yet, the Administration is proposing an ill-advised experiment to drastically cut reimbursements for Medicare Part B drugs that will exacerbate these trends,” said Congressman Boustany, M.D. “This will be especially harmful to rural physicians who are already operating on thin margins, disproportionately impacting public health in rural communities like those in my district in Louisiana. CMS must rescind this rule immediately to avoid placing seniors at risk and further harming public health in rural areas.” 

Ways and Means Committee Chairman Kevin Brady (R-TX) and Energy and Commerce Committee Chairman Fred Upton (R-MI) also expressed the need to stop CMMI’s proposed Part B Drug Payment Model.

“This experiment is irresponsible and it puts the health of our seniors at risk,” said Congressman Brady. “Once again, the Administration is making changes to our health care system without any input from patients, doctors, and health care providers. Their new plan could dramatically affect the quality, accessibility, and cost of care for 75 percent of Medicare beneficiaries. Instead of allowing unaccountable bureaucrats to threaten seniors care, Congress is advancing policies that improve access to the right medication and the right care for all Americans. The 242 members on this letter are making clear that we object to this experiment, and will act to protect America’s seniors and their healthcare.”

Our seniors deserve to be treated with dignity and respect, and the administration’s very suggestion of experimenting with how the elderly are treated is beyond reprehensible,” said Congressman Upton“The potential harm this will cause for seniors in Michigan and across the country is real. I applaud my colleagues from both sides of the aisle for coming forward in such a vocal way to express that this proposal cannot move forward.”

Under CMS’s Medicare drug experiment, numerous physicians would face acquisition costs that exceed the Medicare payment amount for certain drugs. This policy will make it harder for patients to receive the drugs they depend upon.

Medicare currently pays for Part B drugs by reimbursing providers the Average Sales Price (ASP) + 6%. Under the new CMMI model, providers would be reimbursed ASP + 2% plus an additional flat fee of $16.80 per drug per day. Factoring in the impacts of sequestration and prompt pay discounts, the new policy could result in some drugs only being reimbursed at ASP + $16.80.

Furthermore, CMMI is statutorily required to ensure any demonstration model which tests payment or service delivery to specifically target areas where deficits in care have been identified. CMMI is also prohibited from expanding a demonstration model until after a careful analysis of the impact on quality of care, patient access, and spending has been completed.

A signed copy of the letter can be found HERE.