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Medicare to Test New Drug Pricing for Doctors and Hospitals
Medicare is attempting to lower the cost of drugs that provide better benefits to patients.
Not only will their plan lower costs for patients, but the goal is reward doctors when their patients experience better results.
As drug prices soar, the issue of drug pricing has become a staple in political debates and the subject of a number of congressional hearings and probes. In 2015, prescription drug spending totaled $457 billion in the U.S., which is 17% of all health spending.
The experiment focuses on Medicare Part B drugs, which are provided in doctor’s offices or hospital outpatient departments. These drugs include cancer drugs, ey care medications, and injectable antibiotics. Specialty cancer drugs can range in price from $9,000 to $100,000 a month, according to America’s Health Insurance Plans.
The Issue
Currently the Centers for Medicare and Medicaid Services, pays doctors and hospitals the average sales price of a drug plus a 6% fee to cover handling and administration. The add-on payment is believed to be creating an incentive to use higher-price drugs.
Many believe that the incentive influences clinical decisions and bolsters profits without benefiting the actual patient.
“We’ve heard from oncologists that there’s pressure to choose the higher priced drugs even when there’s a lower-priced drug available,” said Dr. Patrick Conway, chief medical officer of CMS. “Doctors want to prescribe medicines without worrying about finances.”
As an experiment, Medicare will solicit comments on several alternative payment approaches for Part B drugs, evaluating which ones provide the highest quality care for the best value.
“Nothing in this proposed payment model will prevent doctors from prescribing exactly the treatment their patients need,” Conway says. “The current perverse incentive system doesn’t benefit patients or the system.”
What do you think about Medicare’s proposed experiment? Will it lower the cost of prescription drugs? Share your thoughts in the comment section below.