Published: Jul 2, 2013
By David Pittman, Washington Correspondent, MedPage Today
WASHINGTON — Congress is looking at several changes to Medicare’s Part B drug program, and its efforts could result in legislation tied to reforming the program’s sustainable growth rate (SGR) physician reimbursement formula.
The House Energy and Commerce Health Subcommittee held a hearing late last week on three bills that address various issues in the Part B drug program. While Part D covers prescription drugs, Part B pays for drugs — such as oncology drugs — that are administered in physician offices or outpatient settings.
Specifically, the three bills are:
H.R. 1416, which would eliminate the sequestration’s effect on physician-administered drugs under Part B
H.R. 1428, which would provide coverage for immunosuppressive drugs for kidney transplant recipients
H.R. 800, which would exclude prompt-pay discounts from manufacturers to wholesalers from the calculation of a drug’s average sale price
Lawmakers pushed for their bills at the hearing on Friday.
H.R. 1416 — the Cancer Patient Protection Act of 2013 — would impact all physician-administered drugs but comes in reaction to oncologists’ outcry that automatic Medicare spending cuts have caused some practices to lose money and stop offering some chemotherapy drugs.
The federal government’s sequester — automatic spending cuts triggered by the 2010 Budget Control Act — cut all Medicare payments by 2% starting April 1.
“It’s the drugs that have been cut, and these drugs are very, very expensive,” sponsor Rep. Renee Ellmers (R-N.C.) said during the hearing. “The physicians have received their 2% cut, but we have to restore that drug cut.”
H.R. 1428, offered by Rep. Mike Burgess, MD (R-Texas), would end Medicare’s practice of stopping coverage of immunosuppressive drugs for kidney transplant patients after 36 months. Burgess said Friday denying coverage of these drugs results in Medicare not protecting the investment of an expensive kidney transplant.
“Oddly, it’s federal policy and not the disease itself that’s the threat to these patients,” Burgess said.
Rep. Gene Green (D-Texas) said his “prompt-pay” bill addresses an unintended consequence of the Medicare Modernization Act which created Part D and made changes to Part B. He said Medicare’s discounts — which are included in the average sales price on which providers’ pay is calculated — reduce the money physicians receive for the drugs they administer to the point where some doctors lose money providing the drugs.
H.R. 800 was part of one version of the Affordable Care Act in 2010 but was left out of the final version of the bill.
The bill would ensure Medicare pays at a rate to maintain a “robust network of providers,” Green said. “This is what we’re trying to do with the SGR reform, and I think Part B rates are part of this larger discussion.”
The bill’s co-sponsor — Rep. Ed Whitfield (R-Ky.) — also urged during Friday’s hearing that the legislation be attached to a larger SGR bill.
The fate of a larger SGR reform bill is still touchy. The House Energy and Commerce Committee could mark up a bill of its own as soon as this month, and released the latest draft of its legislation late Friday.
But it’s already half way through the year and lawmakers still have a long way to go. Members of the Senate have expressed less urgency than their House counterparts about passing a bill to repeal the SGR, and neither chamber has delved into how to pay for a permanent replacement.
Lawmakers said earlier this year that they wanted to repeal Medicare’s physician payment system and replace it with one that rewards quality and value. Energy and Commerce Committee chair Fred Upton (R-Mich.) said in February that he hoped to get a bill passed before the August recess.
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