AHA urges CMS to narrow scope of Part B Drug Payment Model

The Centers for Medicare & Medicaid Services’ proposed payment model for Medicare Part B drugs should not include hospitals, which “have little control over which drugs physicians prescribe in hospital-based settings,” AHA said in comments submitted today. “Even if hospitals could influence physicians’ decisions, there is a dearth of lower-cost, clinically meaningful alternatives available for many of the common conditions treated in hospitals,” wrote AHA Executive Vice President Tom Nickels. If CMS proceeds to include hospitals in Phase I of the model, AHA strongly recommends implementing the model on a much smaller scale and considering other alternative payment options. With respect to Phase II of the model, AHA recommends CMS work with stakeholders to more fully develop the proposals for public review through notice-and-comment rulemaking. The association also expressed serious concern with the payment model’s lack of quality measures, which it said “would be critical to ensuring that the model does not reduce the quality of care while it reduces spending.” The letter also proposes several ways to address rising drug prices in Medicare Part D and beyond, noting that “the responsibility for unsustainable drug pricing ultimately lies with drug manufacturers.”