The plan is to try to reduce the incentive for physicians to prescribe more expensive, but not more effective, drugs.
March 8, 2016 4:44 PM
A proposal by the Centers for Medicare and Medicaid Services would change the way physicians and outpatient departments are reimbursed for the price of medications.
By Steve Twedt / Pittsburgh Post-Gazette
The Centers for Medicare and Medicaid Services is proposing a major change in reimbursements for drugs covered under Medicare Part B.
Currently, CMS says it generally pays physicians and hospital outpatient departments the average sales price of a drug, plus 6 percent.
Under the proposed change, the payment would be 2.5 percent of the average sales price, plus a flat $16.80 payment.
The proposed new rule would lessen the incentive for doctors to prescribe more expensive — but no more effective — drugs to increase the reimbursement, said family physician Patrick Conway, chief medical officer for CMS.
In a media briefing call this afternoon, Dr. Conway said centers have heard from oncologists who felt pressured to order a more expensive drug “even if not appropriate.”
The new rule, published Thursday in the Federal Register, would not prevent a physician from prescribing drugs that he or she believes is necessary but could result in better outcomes for patients “and in smarter spending.”
Medicare will be taking comments on the proposed rule through May 9. Testing of the new proposal will begin late this year in various regions of the U.S.
Steve Twedt: firstname.lastname@example.org or 412-263-1963.
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