Analysis of Part B Demonstration Released

Avalere Health has released a new analysis indicating that the Medicare Part B payment changes recently proposed by the Centers for Medicare and Medicaid Services (CMS) would reduce payments to hospitals and some specialists, while increasing payments to primary care providers. Avalere finds that the demonstration would reduce reimbursement for drugs that cost more than $480 per day. Products costing less than $480 would receive comparatively higher payments. This would redistribute Part B spending across provider types. Hospital outpatient departments are projected to lose the most revenue under the new payment model, and ophthalmologists would be the most effected specialists, followed by oncologists and rheumatologists. Primary care providers and orthopaedic surgeons stand to benefit the most from the proposed program. The study also shows that seven of the ten drugs that would be subject to the largest reduction in reimbursement are used to treat cancer, two are used to treat ophthalmic conditions, and one is used to treat immunologic conditions. More than one million beneficiaries were treated with one of these ten drugs in 2014.

Upcoming Congressional Meetings and Hearings

House Appropriations Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Subcommittee markup of the FY2017 Agriculture/FDA Appropriations Bill; 4:00 p.m., 2362-A Rayburn Bldg.; April 13

House Ways and Means Committee hearing on the Tax Treatment of Health Care; 10:00 a.m., 1100 Longworth Bldg.; April 14

House Education and the Workforce Health, Employment, Labor, and Pensions Subcommittee hearing on “Innovations in Health Care: Exploring Free-Market Solutions for a Healthy Workforce;” 10:30 a.m., 2176 Rayburn Bldg.; April 14

House Energy and Commerce Oversight and Investigations Subcommittee hearing on “Unlawful Reinsurance Payments: CMS Diverting $3.5 Billion from Taxpayers to Pay Insurance Companies;” 9:30 a.m., 2123 Rayburn Bldg.; April 15

House Veterans’ Affairs Committee hearing: “A Continued Assessment of Delays in Veterans’ Access to Health Care;” 10:30 a.m., 334 Cannon Bldg.; April 19

House Veterans’ Affairs Health Subcommittee hearing on: H.R. 2460; H.R. 3956; H.R. 3974; H.R. 3989; draft legislation to ensure that each VA medical facility complies with requirements relating to scheduling veterans for health care appointments and to improve the uniform application of directives; and, draft legislation to direct VA to establish a list of drugs that require an increased level of informed consent”; 10:00 a.m., 334 Cannon Bldg.; April 20

Senate Special Aging Committee hearing on the committee’s investigation into the sudden, aggressive price spikes of decades-old prescription drugs; time and place TBA; April 27

POSTPONED: Senate Finance Committee markup to vote on the nomination of Mary Katherine Wakefield to be deputy HHS secretary; time and place TBD

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