An influential panel proposed capping Medicare Part B pay for some drugs, arguing this would remove financial incentives to use more costly medicines when there are less expensive equivalents.
Medical groups have objected to both this recommendation from the Medicare Payment Advisory Commission and the panel's underlying premise. MedPAC said financial as well as clinical factors can come into play in clinicians' choices of drugs for patients.
MedPAC members voted 17-0 in April in favor of a general recommendation to revise the Part B payment approach. In the June report, MedPAC fleshes out this idea. It mentions a model in which the add-on Part B payment would be the lesser of either 6% of the ASP, 3% plus $24, or $220. Association's Specialty Society Relative Value Scale Update Committee , MedPAC said. AMA's RUC advises the Centers for Medicare & Medicaid Services on the physician fee schedule.
, for example, would prohibit PBM compensation based on the price of a drug as a condition of entering into a contract with a Medicare Part D plan."Until that happens, we can put all the lipstick we want on this big pig, but it's not going to really fix the problem," she said.
MedPAC in 2016 urged CMS to reduce the amount Medicare pays for drugs acquired through the 340B program. CMS did so during the Trump administration, a policy later defended by the Biden administration. MedPAC commissioners discussed this idea at a January meeting, prompting a February letter from the AHA to the panel. Like Feldman, AHA also said it would be"premature" to launch into a revision of Part B drug pricing while the impact of the IRA on drug prices was still unclear.
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