AMA Calls on CMS to Drop Proposed Reimbursement Change for Part B Drugs

The American Medical Association (AMA) is asking the Centers for Medicare & Medicaid Services (CMS) to drop a proposal to change how Medicare reimburses medications under Part B. If CMS fails to act, the association resolved to lobby Congress to take action to block the proposed change from implementation, according to a report in MedPage Today.

The move came during a House of Delegates session at the AMA annual meeting in Chicago last month. According to a resolution passed by the House of Delegates, the CMS proposal “would significantly undermine the ability of physician practices to meet the significant administrative and financial burdens associated with the rapidly evolving healthcare environment.”

Currently, Medicare Part B reimburses practices the average sales price of a drug with a 6% add-on fee, the MedPage Today report explained. The proposed plan would scratch that formula and replace it with the following: the average sales price of a drug plus 2.5% plus a $16.80 flat fee per drug per day.

Physicians, particularly oncologists, have categorized the plan as nothing but a reimbursement cut that would hurt practices and patients alike. AMA members were united in their comments against the plan during the House of Delegates meeting.

“This will impact care of our patients, especially those with ovarian cancer,” Heather Smith, MD, speaking on behalf of the American Congress of Obstetricians and Gynecologists, reportedly told the House of Delegates.

“The reality is that drug control by decreasing prices will not ultimately lower drug costs,” added Edward Balaban, DO, who spoke on behalf of the American Society of Clinical Oncology, MedPage Today reported. “That’s been demonstrated in our practices over and over. We can’t let this take place.”

The proposal has sparked outrage from many physicians since its announcement. In May, 238 Republicans and 4 Democrats in the US House of Representatives penned a letter to Andy Slavitt, acting administrator of CMS, asking him to withdraw it.

“CMS’s proposed Medicare experiment would impose cuts in Phase 1 that will severely harm patient access to needed drugs,” the MedPage Today report quoted from the letter. “Under CMS’s Medicare drug experiment, numerous physicians would face acquisition costs that exceed the Medicare payment amount for certain drugs.”—Jolynn Tumolo