CMS' proposed cancer drugs pilot attracts support and condemnation

By Aine Cryts

A proposed pilot by the Centers for Medicare & Medicaid Services (CMS) to change how it reimburses doctors for providing chemotherapy and other injectable drugs is drawing both support and condemnation, reports The Washington Post.

In the pilot, doctors will receive a flat fee for these drugs, plus 2.5 percent of the price of the drugs (a number that was reduced to .9 percent under the federal budget sequester). Currently, doctors are paid the average sales price of these drugs, plus 6 percent (or 4.3, under the sequester), according to the article.

CMS proposed the pilot to put a stop to incentives that encourage doctors to prescribe the highest cost drugs. Proponents, including groups such as Families USA, AARP and Medicare Rights Center, have supported the pilot as a way to deliver high-value care to Medicare patients.

Opponents, however, told the publication that the pilot will have a negative impact on cancer care for seniors covered by Medicare. The Community Oncology Alliance, a nonprofit representing healthcare providers, told the newspaper that the pilot is "an inappropriate, potentially dangerous and perverse experiment on the cancer care of seniors who are covered by Medicare."

One analysis shows physicians would get better reimbursement under the pilot for older, generic drugs and a less generous reimbursement for more expensive, new drugs. "The reimbursement system has created an opportunity to charge very high prices, so much so that the profits of doctors on balance revolve around these very few drugs (really the top 10 or so) and that doctors' and hospitals' interests are entirely aligned with the prices of these drugs staying high (and going higher)," Peter Bach, director of the Center for Health Policy Outcomes at Memorial Sloan Kettering Cancer Center, whose team conducted the analysis, told the news outlet.

To learn more:
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