Congressional leaders are being urged by several leading medical societies, including the AUA and the American Society of Clinical Oncology, to prevent the Centers for Medicare & Medicaid Services (CMS) from applying Merit-based Incentive Payment System (MIPS) adjustments to Part B drug payments.
In letters recently sent to the chairs and ranking members of the Senate Finance, House Ways and Means, and House Energy and Commerce committees, the specialty groups warn that such action by CMS could jeopardize patients’ access to critical drug treatments.
Ability to provide Part B drugs ‘at risk’
The groups said applying MIPS adjustments would “put at risk the ability of specialists to provide the physician-administered drugs on which their patients depend,” noting that drugs covered under Medicare Part B include therapies that are typically administered by a physician, either in an independent practice or outpatient setting. The drugs are not generally available at pharmacies and are not part of Medicare Part D prescription drug plans.
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Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress established a range of bonuses and penalties to which Medicare providers could be subjected through MIPS payment adjustments. In its 2018 Quality Payment Program final rule, CMS announced that it will immediately begin to impose these payment adjustments to Part B drug payments in addition to physicians' services under the Medicare fee schedule, a decision that represents a significant departure from current policy.
“We believe this policy is not consistent with congressional goals in the bipartisan passage of MACRA,” the letter states. “In the final rule, CMS states that the statute leaves them no flexibility in how to implement policy. If left as is, this policy will negatively impact patients’ access to critical life- and sight-saving treatments by putting specialties that provide high-cost drugs at risk. It will significantly amplify the range of bonuses and penalties intended by MACRA, only for certain specialties.”
In the letter, the groups said, "While we had substantial and bipartisan congressional support for a message to CMS to reevaluate their interpretation of the MACRA statute, CMS did not heed that request. We now need Congress to act immediately to curtail this policy and ensure patients have access to all the services and treatments they need."