The Centers for Medicare & Medicaid Services intends to test whether phasing down the Medicare payment amount for selected Part B drugs to more closely align with international prices will meet President Trump’s blueprint to lower drug costs and reduce out-of-pocket costs for patients.
CMS is soliciting public comments by Dec. 31 on this and other options to consider for testing changes to payment for certain separately payable Part B drugs and biologicals.
In addition to testing whether phasing down the Medicare payment amount for selected Part B drugs to more closely align with international prices, other options include 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 in the spring of 2019 on the potential model, called the International Pricing Index (IPI) Model. The potential IPI Model would start in spring 2020 and operate for five years, until the spring of 2025. Over the course of the model, CMS would monitor and evaluate the impact of the model on beneficiary access to drugs, program costs, and the quality of care for beneficiaries.
Through the advance notice of proposed rulemaking (ANPRM), CMS is seeking feedback by Dec. 31 on the potential parameters of the IPI Model. The ANPRM can be downloaded from the CMS Newsroom at: https://www.cms.gov/sites/drupal/files/2018-10/10-25-2018%20CMS-5528-ANPRM.PDF . VTN
