The Centers for Medicare and Medicaid Services (CMS) have been trying to revise Medicare Part B for several months now. Their aim is to remove financial considerations from the prescribing of medicine; this movement stems from the discovery that for some practices, especially oncology, revenue from prescriptions makes up over half their profits. At one meeting, a CMS official heard a physician say he didn’t prescribe a specific medication to a patient purely due to cost considerations.
Currently, Medicare reimburses hospitals and clinics for the average market cost of the drug plus an additional 6% to cover costs like staffing. The proposal would reduce that to a 2.5% reimbursement for costs plus a flat rate of $16.80 per drug per day.
Controversy immediately ensued when this proposal was made, with doctors insisting that these reimbursement cuts would mean some drugs were unavailable to patients due to cost and lack of funding for staff. Rural oncologists are especially concerned that their patients could lose access to drugs, or that the full cost of some necessary drugs will not be covered. Medicare is now taking a closer look at specific situations to determine how this proposal can best serve both patient health and hospital revenue efficiency. Read more about the concerns and solutions here.