Comment on New Medicare Part B Prescription Drug Models

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  • March 9, 2016
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Comment on New Medicare Part B Prescription Drug Models

The Centers for Medicare & Medicaid Services (CMS) announced March 8 a proposed rule that, when finalized, would allow testing of new Medicare Part B prescription drug models. The federal agency is soliciting comments from stakeholders on six alternative payment models to help find one that would better align physician incentives to successful patient outcomes.

The Proposed Models

  1. Improving incentives for best clinical care. This model would change the add-on payment from 6 percent to a budget neutral 2.5 percent plus a flat fee payment of $16.80 per drug, per day.
  2. Discounting or eliminating patient cost-sharing. This model would decrease or eliminate cost sharing to improve beneficiaries’ access to the medication they need.
  3. Feedback on prescribing patterns and online decision support tools. This proposed model would create evidence-based clinical decision support tools for providers and suppliers to use to track best practices in prescribing and information on prescribing patterns relative to location and trends.
  4. Indications-based pricing. This model would test varying the payment for a drug based on its clinical effectiveness for different indications.
  5. Reference pricing. This proposed model would test the practice of setting a standard payment rate, or benchmark, for a group of therapeutically similar drug products.
  6. Risk-sharing agreements based on outcomes. This model would allow CMS to enter into voluntary agreements with drug manufacturers to link patient outcomes with price adjustments.

CMS is accepting comments on this proposed rule through May 9, 2016. The proposed rule will be published March 11 in the Federal Register.

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

No Responses to “Comment on New Medicare Part B Prescription Drug Models”

  1. hoffmanloretta says:

    In fact, prescription drugs have taken the highest toll of lives due to overdose of the drug. 3 In 2005 alone, 22,400 people lost their lives due to over dose of drugs and among them 38.2 % deaths accounted to opioid pain killers alone. Prescription drugs are the most commonly abused substance whose overdose leads to death in large amounts. 3 In 2006, 2.6 million people abused prescription drugs for the first time, in United States alone. The average age of the first timers have become 13 to 14 these days.