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On Capitol Hill, A Battle Brews Over Administration’s Medicare Part B Pilot Program

Medicare 1Washington, DC, April 29, 2016 ― Peter Sullivan reports in The Hill that an Obama administration Medicare Part B proposal, aimed at fighting high drug prices, is facing a backlash on Capitol Hill.

Republicans say the pilot program that would change how Medicare pays for certain drugs should be scrapped.

Meanwhile, congressional Democrats are expressing serious concerns and seeking changes, but generally do not want to terminate it completely.

Rep. Larry Bucshon (R-Ind.) told The Hill that he plans to introduce a bill today that would block the program; he expects some Democrats to support it.

At issue is a five-year pilot program that would change the way Medicare Part B pays for drugs.

Currently, Medicare pays doctors the average price of a drug plus 6 percent.  The administration warns that system gives doctors an incentive to prescribe higher cost drugs so that they get paid more.  The pilot program would reduce the 6 percent add-on to 2.5 percent plus a flat fee of about $16.

So far, the proposal is finding little support in Congress.  Every Democratic senator on the Senate Finance Committee joined a letter to the administration on Thursday calling for changes to the program before it moves forward.

The Finance Committee Democrats warned that the program could harm patients by limiting their access to treatments if doctors’ costs to acquire drugs become higher than the reimbursement rate for Medicare.

House Democrats, led by Rep. Richard Neal (D-Mass.), are circulating a similar letter that expresses 11 different concerns with the effort, including about patient access to drugs, the impact on rural doctors, and a shortage of stakeholder input. That letter was first reported by the Huffington Post.

In addition, Sullivan reports that some powerful interest groups are strongly against the proposal and are pressuring Congress to act.

The Pharmaceutical Research and Manufacturers of America (PhRMA) has denounced the plan, as have some medical provider groups, like the association representing cancer doctors.

To access Sullivan’s full story, click here.