The Centers for Medicare & Medicaid Services (CMS) issued an advance notice of proposed rulemaking seeking comments through Dec. 31 on options under consideration as part of the three-pronged drug plan announced by President Trump last week.
CMS intends to test whether the following changes would lead to higher quality of care for beneficiaries and reduced expenditures for the Medicare program:
- Phasing down the Medicare payment amount for selected Part B drugs to more closely align with international prices;
- Allowing private-sector vendors to negotiate prices for drugs, take title to drugs and compete for physician and hospital business; and
- Changing the 4.3 percent (post-sequester) drug add-on payment in the model to reflect 6 percent of historical drug costs translated into a set payment amount.
CMS is considering issuing a proposed rule next spring on the potential model, called the International Pricing Index Model. The model would start in spring 2020 and operate for five years. Over the course of the model, CMS would monitor and evaluate the impact on beneficiary access to drugs, program costs and the quality of care for beneficiaries. Participation in the IPI model would be mandatory for physician practices, hospital outpatient departments and potentially other Part B providers and suppliers that furnish the model’s included drugs in the selected geographic areas. For more information, see the CMS fact sheet.
The Department of Health and Human Services also released a report comparing the prices paid for physician-administered drugs in the U.S. to certain other countries.