Physicians across the country are concerned about keeping the Centers for Medicare & Medicaid Services from imposing quality-program penalties and bonuses on Part B drug payments.
Across the country, physicians are urging Congress to oppose this proposal, which could compel some solo-practice physicians to limit the Part B drug-related services they offer.
Representative Erik Paulsen (R-MN) is working to preserve access to Part B drugs by sending a letter to Health and Human Services Secretary Tom Price, MD, that expresses concerns regarding a proposal to include Part B drugs in the application of Medicare payment adjustments under the new Merit-based Incentive Payment System (MIPS).
The Centers for Medicare and Medicaid Services (CMS) is proposing that it apply positive and negative payment adjustments required under MIPS to these Part B drug reimbursements. This is a significant departure from previous policy as none of the MIPS legacy programs, including Meaningful Use (MU), the Physicians Quality Reporting System (PQRS) and the Value-based Modifier (VBM), applied related adjustments to reimbursement for drugs. These are essentially pass through payments for the cost of acquiring these drugs so applying either bonus or penalty adjustments to them would be inappropriate.
This proposal could negatively impact patient access to critical treatments. In addition, many physician organizations do not believe that Congress intended for CMS to apply MIPS bonuses and penalties to Part B drug reimbursements when it enacted the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015.
The Paulsen letter urges CMS to reevaluate its interpretation of the MACRA statute to ensure your patients have access to all the services and treatments they need. Physicians can make a difference by contacting their Congressional Representatives and Senators to join in the effort.
What you can do:
- Ask your representative in the US Congress to sign Representative Erik Paulsen’s letter calling for U.S. Health and Human Services Secretary Tom Price, MD, to exempt Part B drug payments from penalties.
- Ask your representative in the US Congress to help ensure access to compounded office-use treatments.
Physicians can aid the effort to preserve patients’ access to compounded, office-use antibiotics and antivirals. A bipartisan proposal in the U.S. House of Representatives would let traditional compounding pharmacies distribute these drugs without a patient-specific prescription in states that allow office-use compounding.
- Ask your representative in the US Congress to support the Preserving Patient Access to Compounded Medications Act from Reps. Morgan Griffith, R-Va., and Henry Cuellar, D-Texas.
Click here to look up your Congressional representative and access their online email form, address and phone number.