Medicare Part B Rule to be Finalized in March 2019

May 24, 2016

Published by: Jeanne Ellinport

Congratulations!  Your letters and calls worked.  The Centers for Medicare and Medicaid Services (CMS) announced on Monday, May 23 that they do not expect the controversial Medicare Part B drug cost-cutting demonstration rule to be finalized until March 2019. Published by CMS in March, the proposed Medicare Part B would change the add-on percentage of drugs from 6% to 2.5%, along with a flat fee payment of $16.80 added per drug per day. 

According to Ph.D. Adam J. Fein, President of Pembroke Consulting and CEO of Drug Channels Institute, the drug reimbursement accounts for more than 70% of the clinics revenues.  Therefore, one unintended consequence of the Part B Drug Payment Model would likely have been a shift in some care to higher-cost settings.  Unfortunately, if providers are unable or unwilling to dispense a medically necessary Part B drug due to the reimbursement rate, beneficiaries who need that treatment may have no choice but to seek care in a higher-cost setting of care.  This result would be particularly problematic for beneficiaries who reside in rural areas who have fewer treatment options and who may be forced to travel further distances to receive care. 

The delay of the proposal is an excellent news. It protects an avenue for patients to get access to cancer drugs and treatments from a convenient location with a fair price more easily. We thank you for your effort to help postpone the proposal.

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