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MedPAC Mulls Changes to Part B Drug Program

(MedPage Today) March 3, 2017 - The Medicare Payment Advisory Committee (MedPAC) says that the way physicians are paid for administering drugs under Part B of the Medicare program should be changed, but not all committee members agree on how that change should occur.

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Winston Wong, PharmD (Posted: March 09, 2017)

quotesI am not sure that the consolidated billing for biosimilars is a good idea, mainly because these drugs are not interchangeable. Using a single consolidated J-code will imply that these drugs can be substituted for each other, and they are not. I am also concerned that using the WAC will eventually lead us back to the issue we saw with the inflated AWP.quotes

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Thomas Marsland, MD (Posted: March 08, 2017)

quotesWow.... maybe MedPac actually came up with a couple of good thoughts. This article is definitely worth looking at. They address the ASP issue and rising drug costs by limiting the amount the company may increase the price in a given period of time. This is a dramatic change from the idea that they can control drug costs but reducing the add on (ASP "+") that is the fee to the practice for drug handling. I like the idea of consolidated codes. It clearly has been helpful in the generic world and if done properly should work for biosimilars and even drugs within a give type that have equal efficacy and toxicities. The DVP idea is also one that deserves being looked at (darn, lot of dangling pariticiples today...). This is one way of allowing Medicare to "negotiate" pricing through an intermediary. The proposal removes the outside negotiating vendor from the direct patient billing and issue of drug procurement for the practice that was very problematic in the CAPS program. Clearly the "administrative" fee would need to be adequate to cover practice expenses on drug handling but we should be open to the idea. It would be interesting if this did then qualify as an APM. It wasn't really clear in the report if that was just an idea or was that a key part of the proposal. The final piece of this article that was very interesting was the discussion of a "virtual" group - a concept I had only very recently heard of ( darn again...). Once more the devil is in the details. Who is in the group??? What metrics are being looked at??? This would go a long way toward being sure that in any performance based payment model that you really are being compared to your peers in terms of quality outcomes and costs. No longer would the oncologist be compared to the internist. Gee maybe MedPac isn't so worthless after all......quotes

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