One month after the Obama administration unveiled an experiment to revamp the Medicare Part B program, more than a dozen Republican Senators are urging that it be withdrawn. At the same time, House Republicans and Democrats are circulating letters among themselves that express varying degrees of concern with the program.

In a letter sent on Friday to the US Centers for Medicare and Medicaid Services, the Senators charged that the program would “severely disrupt care for vulnerable beneficiaries with cancer” and other serious medical conditions. They also complained that CMS failed to undertake a fully transparent process to assemble its program.

At issue is an attempt by the administration to encourage greater use of lower-cost, but equally effective treatments. The Part B program covers injectable and infused medications for the elderly. The government also maintains its plan will be budget-neutral, or will not cost additional money.

advertisement

Under the Part B program, doctors, and hospitals buy a medicine, and the government reimburses the average sales price plus 6 percent. But the experiment, which would run five years starting this fall, would pay physicians the average price, plus another 2.5 percent and a flat fee of $16.80, not including reductions required by sequestration, or automatic spending cuts. The program would also pursue ways to pay for medicines based on different definitions of value.

As we noted previously, the move reflects growing concern over the rising cost of medications, a hot-button topic that is straining payer budgets and angering Americans. The administration hopes to lower its drug spending by reducing reimbursement fees for physicians.

The missive from the senators is not surprising. Even before the administration unveiled its program last month, there was heated opposition. Since then, more than 300 groups representing physicians, drug makers, and patients also released a letter that encouraged the administration to withdraw its proposal. And many of these groups have been lobbying Congress.

“The proposal, which was rushed through review without physician or patient input, lays out an experiment (that is) not based on quality metrics,” said the Community Oncology Alliance, a trade group that represents smaller cancer clinics, at the time the program was unveiled last month.

The administration “intends to drive the selection of cancer drugs toward a CMS definition of value, rather than the most appropriate treatment determined by oncologists in close collaboration with their patients.”

Some physicians are upset because they believe the administration will unfairly penalize them for administering more expensive medicines. They also argue that changing reimbursement formulas does nothing to lower drug prices.

In recent days, members of Congress have been circulating letters to their colleagues. A letter proposed by House Republicans, which was reported by The Huffington Post, also urges the administration to withdraw the program. But a letter that House Democrats have circulated instead, suggests that the administration find a way to address the same concerns, but does not specifically mention nixing the program.

Just the same, the letter from the House Democrats could work toward slowing the administration program. However, a spokesman for House Democratic Leader Nancy Pelosi told us that the “members are outlining their concerns, but this letter is in furtherance of getting an effective rule in place under the current timeline. This is no way an effort to slow down or undermine the administration’s efforts.”

Leave a Comment

Please enter your name.
Please enter a comment.

  • As a former democrat, turned independent, I can assert with absolute certainty that Obama is no friend of either social security or medicare. He underfunded social security by 1/4 of a trillion dollars with his 2011 and 2012 payroll tax credits (each year underfunding the program by $125 billion), we have no COLA increase on social security for 3 of the 7 years Obama has been in office and can expect almost none his last year in office, and he cut $750 billion from medicare at least one year that he’s been in office, which he called a reduction of waste and fraud, which was a cut in benefits, no matter what he called it.

  • This is the intention. Dr Ezekiel Emmanuel, one of the architects of OBAMA CARE says that the reason healthcare is so expensive it that it’s based on individual patient’s needs. There most be a shift away from that paradigm to what benefits society as a whole. What is the minimal amount of healthcare needed to sustain the healthiest portion of the population? The elderly and the sickly young must be jettisoned when healthcare is to be rationed. This is just the beginning with the Medicare Part B experiment.

  • Please try to understand that if you cut Medicare payments on certain specific treatments thousands, or tens of thousands people will have their very lives at stake, including mine. Before starting immunoglobulin infusions at home, I was in the hospital all the time with lung infections, sinus infections, pancreatitis; my lungs are irreversibly damaged due to late diagnosis and treatment. Without my weekly infusions, I will get sick, then sicker and sicker until death takes me. My death, and so many more, will be in your hands if you cut our benefits. Say it: I will die without my infusions.

  • if you are on Medicare and don’t like it, get out. You do not have to use a government program if you don’t like it. Go back to the old system, although you probably would not get any care unless you paid your own way, because no insurance company would insure you. But at least you would get “the no good government” out of your life.

  • Why not spend the same amount of time and resources encouraging the drug companies to manufacture lower priced drugs with the same effects. The drug companies have us (especially the senior population) at gu point
    Why not spend the same amount of time and resources monitoring and encouraging the drug companies to produce more inexpensive drugs with the same effects. The drug companies have this country (especially the senior population) in their grasps. The salaries and bonuses of drug company executives in this country is ludicrous. And the prices we are paying for drugs is criminal. Address this issue instead of penalizing the doctors and patients!!

  • STOP this insanity, we all deserve the best quality medical care, we paid into the system!! Save money by GIVING free healthcare to the people that have NOT contributed into the system!!!!!!!!!!!!!!!!!!!!!

  • If there is to be any help, it needs to be a reduction in the prices of almost all medicines! Drug companies are greedy beyond comprehension. Sinful!

  • Humm, who loses $? The doctors and hospitals get the average retail plus 2.5% plus a flat $16.50 instead of 6%. The average sales price stays the same. The doctor or hospital can still select any drug they want. So, it seems like the doctors and hospitals are out the additional 4.5% of the astronomical drug price for sitting the patient down and sticking in a needle. Is that the problem??? When paid as a straight percentage of the average retail, doctors and hospitals get paid more and patient and government get the same. Humm. Whose problem is this? Bring on the lobbyists. They are sure to help.

    • If you think delivering chemotherapy or other infusion drugs is just ‘sticking in a needle’ you are sorely mistaken. It requires a hell of a lot more specialized work and attention for which the doctors don’t get paid. Also, if you read some of the opposition the issue isn’t that they are going to cut income by a % of money, it is that they will literally be losing money on drugs. And finaly, if you trust the government to come up with a decision that one drug is more valuable than the other I wouldn’t. Wait until someone you love has cancer and then decide if you want the best drugs out there being restricted because someone in DC says it should be.

  • Obama is actually trying to keep cost under control. The GOP pharma buddies feel they might not be able to scam the system as much, so they are reacting. What a shock.

    • Both of you are wrong. The Medicare Modernization Act created the ASP
      (average selling price) rule. In essence they created it and now they have buyer’s remorse. CMS has cut physician payments consistently over time and we may lose good community physicians- which studies have shown lower the overall healthcare costs rather than hospitals. Check COA’s website.
      If CMS cuts the ASP- community practices will be hurt. The costs to obtain, store and administer drugs is expensive. The subject matter is complex and being flippant serves no purpose in comments when you don’t understand. It is better that noneducated people not comment on things they don’t understand.
      Healthcare is a business in the US. We are a capitalist society. It is a government that I believe works. People continually try to change America to a government controlled society. Why? If one does not like it go then they need to go to another country. Good luck on getting adequate health services especially in India, Canada, Italy and Greece. That’s a whole other complex issue in healthcare.
      Our healthsystem is not broken but it is fragmented. That has been the nature of the evolution of healthcare. We have had a lack of tools. As we became more technically savvy healthcare will benefit.
      Our government knew that the aging baby boomers were coming and they did nothing to prepare for this demand on healthcare. All we have is our humanity and we should take care of everyone’s health- top priority.

Your daily dose of news in health and medicine

Privacy Policy