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CMS proposes new payment model for Medicare Part B Print E-mail
Written by The Health Law Offices of Anthony C. Vitale   
Tuesday, 05 April 2016 17:32

The Centers for Medicare and Medicaid Services (CMS) is proposing a new rule that could result in a new Medicare Part B drug payment model. Published in the Federal Register, the agency is proposing a two-phase model that would test whether alternative drug payment designs would result in a reduction in Medicare costs, while at the same time preserve, or even enhance, the quality of care for Medicare beneficiaries.

Under the existing methodology, expensive drugs receive higher add-on payment amounts than less expensive drugs, while there are no clear incentives for providing high-value care, including drug therapy. It's hoped that under the new model providers would be incentivized to prescribe the most effective drugs and link payments to patient outcomes.

"We hope that the revised pricing will remove any excess financial incentive to prescribe high cost drugs over lower cost ones when comparable low cost drugs are available," writes CMS. "In other words, we believe that removing the financial incentive that may be associated with higher add-on payments will lead to some reduction in expenditures during phase I of the proposed model."
Last Updated on Tuesday, 05 April 2016 17:35

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