CMS nixes Medicare Part B demonstration

drugs
CMS has decided to scrap its proposed Medicare Part B payment model demonstration.

In response to considerable backlash, the federal government has decided to nix its proposed Medicare Part B payment model demonstration.

The Centers for Medicare & Medicaid Services was aiming to test a model that would create incentives for patients and physicians to select lower-cost, high-performing drugs that are administered at medical facilities. The demonstration was set to run for five years, and would have been mandatory for all providers and suppliers that furnish and bill for Part B drugs.

“While there was a great deal of support from some, a number of stakeholders expressed strong concerns about the model,” CMS spokesman Aaron Albright said in an emailed statement. “While CMS was working to address these concerns, the complexity of the issues and the limited time available led to the decision not to finalize the rule at this time.”

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Industry groups including drug manufacturers and oncologists lobbied hard against the proposal, arguing it was too broad in scope and saying it put too much focus on saving money at the expense of ensuring patients' access to life-saving treatments. Lawmakers on both sides of the aisle also pushed back against the proposal based on complaints from their constituents, though Republicans were more critical than Democrats.  

But some were critical of the backlash itself, pointing out than many of the lawmakers who opposed the proposal received hefty contributions from the pharmaceutical industry, and some patient advocacy groups that came out against it also had ties to drugmakers.

CMS Chief Medical Officer and Principal Deputy Administrator Patrick Conway had defended the proposal, saying the intent was to “remove financial considerations from the prescribing of medicine.” Yet he also indicated that the agency was open to tweaking it in response to stakeholders’ concerns.

The American Medical Association, though, hailed CMS’ decision to scrap the demonstration entirely.

“This is a model for how Washington should—but often doesn’t—work,” the group said in an emailed statement, noting that the Center for Medicare & Medicaid Innovation asked for feedback and the AMA and others explained how the proposal would hurt patient care. “CMMI then re-evaluated its original proposal, resulting in the announcement that CMS would not go forward with these changes. We are grateful that CMS came to the right decision after listing to stakeholders.”

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