ACR: New Medicare International Pricing Index should be voluntary

Paula Marchetta

The American College of Rheumatology on Thursday urged caution regarding CMS’ proposed International Pricing Index, or IPI, model for Medicare Part B drugs, and recommended that the new program be voluntary for providers and include a possible exit for those who cannot satisfy the administrative and financial requirements.

In a comment letter to CMS Administrator Seema Verma, ACR President Paula Marchetta, MD, MBA, wrote that she is concerned that, without “substantial changes,” the new drug pricing model could exacerbate the looming rheumatology workforce shortage and deepen geographic disparities regarding patient access to medical care.

“We appreciate the opportunity to provide input on the proposed IPI model and are encouraged by the agency’s efforts to make needed therapies more affordable for patients,” Marchetta said in a press release. “However, we believe that changes must be made to ensure the proposal does not result in significant disruptions in patient care for the 54 million Americans who live with a rheumatic disease.”

 
The ACR has recommended that the IPI program be voluntary for providers and include a possible exit for those who cannot satisfy the administrative and financial requirements.
Source: Shutterstock

CMS announced the International Pricing Index in October with an Advance Notice of Proposed Rulemaking. The proposal’s goal is to shift Medicare payments for select physician-administered drugs to a level more closely aligned with prices in other countries. According to CMS, the program would save American taxpayers and patients $17.2 billion over 5 years.

Under the program, which is slated to potentially begin in spring 2020, private vendors would procure drugs, distribute them to physicians and hospitals, and take on the responsibility of billing Medicare. Vendors would aggregate purchasing, seek volume-based discounts and compete for providers’ business, thereby creating competition where none exists today, CMS said in its October announcement.

“Under the model, instead of the current percentage-based add-on payment, physicians and hospitals would receive a set payment amount for storing and handling drugs that would not be tied to drug prices,” CMS stated in a release. “Therefore, the IPI model would remove the financial incentive to prescribe higher-cost drugs. The model also frees physicians from having to ‘buy and bill’ high-priced drugs, which creates financial risk that jeopardizes their practice and the ability to serve their community.”

The ACR is recommending three specific changes to the new model. In addition to making the new system voluntary, the group is also asking CMS to reduce its size and scope, and cover a significantly smaller percentage of Part B drug administration in order to “avoid disruptions in patient care.”

In addition, the ACR recommended that the financial and administrative burdens to physicians be reduced.

“In order to avoid disruptions in patient access to treatments, ACR opposes any increased risk to patients and practices as a result of the demonstration,” read the group’s release. “The ACR is concerned that the proposal to have providers collect patient cost-sharing payments would create serious financial risk and administrative burdens for physicians, particularly those operating small practices.”

Instead, the ACR recommended that if third-party vendors are tasked with drug procurement and distribution under the proposed model, that they also collect the payments themselves, or otherwise pay providers a fee for the cost collection.

Lastly, the ACR recommended that CMS continuously track and report measures, including prescription adherence, out-of-pocket costs and disease outcomes, throughout the program to ensure the model does not impede patient access or health outcomes “in favor of lower costs.”

“The ACR is dedicated to ensuring that rheumatologists and rheumatology care professionals have the resources they need to provide patients with appropriate, high-quality care,” Marchetta said in the release. “We thank CMS for providing an opportunity to offer our input and we look forward to serving as a resource for the agency as it works to lower drug costs for Americans with chronic illnesses.” – by Jason Laday

Paula Marchetta

The American College of Rheumatology on Thursday urged caution regarding CMS’ proposed International Pricing Index, or IPI, model for Medicare Part B drugs, and recommended that the new program be voluntary for providers and include a possible exit for those who cannot satisfy the administrative and financial requirements.

In a comment letter to CMS Administrator Seema Verma, ACR President Paula Marchetta, MD, MBA, wrote that she is concerned that, without “substantial changes,” the new drug pricing model could exacerbate the looming rheumatology workforce shortage and deepen geographic disparities regarding patient access to medical care.

“We appreciate the opportunity to provide input on the proposed IPI model and are encouraged by the agency’s efforts to make needed therapies more affordable for patients,” Marchetta said in a press release. “However, we believe that changes must be made to ensure the proposal does not result in significant disruptions in patient care for the 54 million Americans who live with a rheumatic disease.”

 
The ACR has recommended that the IPI program be voluntary for providers and include a possible exit for those who cannot satisfy the administrative and financial requirements.
Source: Shutterstock

CMS announced the International Pricing Index in October with an Advance Notice of Proposed Rulemaking. The proposal’s goal is to shift Medicare payments for select physician-administered drugs to a level more closely aligned with prices in other countries. According to CMS, the program would save American taxpayers and patients $17.2 billion over 5 years.

Under the program, which is slated to potentially begin in spring 2020, private vendors would procure drugs, distribute them to physicians and hospitals, and take on the responsibility of billing Medicare. Vendors would aggregate purchasing, seek volume-based discounts and compete for providers’ business, thereby creating competition where none exists today, CMS said in its October announcement.

“Under the model, instead of the current percentage-based add-on payment, physicians and hospitals would receive a set payment amount for storing and handling drugs that would not be tied to drug prices,” CMS stated in a release. “Therefore, the IPI model would remove the financial incentive to prescribe higher-cost drugs. The model also frees physicians from having to ‘buy and bill’ high-priced drugs, which creates financial risk that jeopardizes their practice and the ability to serve their community.”

The ACR is recommending three specific changes to the new model. In addition to making the new system voluntary, the group is also asking CMS to reduce its size and scope, and cover a significantly smaller percentage of Part B drug administration in order to “avoid disruptions in patient care.”

In addition, the ACR recommended that the financial and administrative burdens to physicians be reduced.

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“In order to avoid disruptions in patient access to treatments, ACR opposes any increased risk to patients and practices as a result of the demonstration,” read the group’s release. “The ACR is concerned that the proposal to have providers collect patient cost-sharing payments would create serious financial risk and administrative burdens for physicians, particularly those operating small practices.”

Instead, the ACR recommended that if third-party vendors are tasked with drug procurement and distribution under the proposed model, that they also collect the payments themselves, or otherwise pay providers a fee for the cost collection.

Lastly, the ACR recommended that CMS continuously track and report measures, including prescription adherence, out-of-pocket costs and disease outcomes, throughout the program to ensure the model does not impede patient access or health outcomes “in favor of lower costs.”

“The ACR is dedicated to ensuring that rheumatologists and rheumatology care professionals have the resources they need to provide patients with appropriate, high-quality care,” Marchetta said in the release. “We thank CMS for providing an opportunity to offer our input and we look forward to serving as a resource for the agency as it works to lower drug costs for Americans with chronic illnesses.” – by Jason Laday

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