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Reasons to be optimistic about the new Medicare Part B payment models


The federal government's new Medicare Part B payment model proposals have stirred up considerable controversy, but the tests may actually be worth a try in order to tackle the spiraling costs of prescription drugs, according to an opinion piece from STAT.

The proposals, which will shift the reimbursement model for doctors who choose to prescribe less expensive but equally effective medications over their expensive counterparts, has received backlash from industry stakeholders. Both drug manufactures and oncologists said that the government's proposals put too much focus on saving money and too little on ensuring patients' access to treatment. Oncologists are specifically afraid of the penalties they may face for prescribing more expensive medications, even if those medications are better than their lower-priced counterparts.

But the STAT piece argues that the proposed five-year tests alone would be worth the effort because if successful, they could have major implications for drug price trends. The changes would force physicians to do a bit more math, but that math is nothing compared to potential behavior modifications that could tamp down rising health costs, it adds.

One Wall Street analyst, the STAT piece notes, even said the proposal may "subtly alter the competitive dynamics" of the pharmaceutical drug market.

The article also points out that a lot of the industry pushback can be attributed to the high level of uncertainty with the government's proposals. No one actually knows how the new reimbursement model will work out, and only estimates have been released in terms of its effectiveness. The government, for example, has said that Medicare Part B payments to oncologists, which totaled $1.2 billion in 2014, would have declined by 0.7 percent this year had the plan been in effect last year--but those numbers are only guesses.

To learn more:
- here is the STAT article

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Feds to test new Medicare Part B payment models
How insurers, policymakers could drive value-based drug pricing