CMS Proposed Part B Drug Payment Model


As you are aware, on March 8, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining a 5-year Part B Drug Payment Model demonstration that would test various Part B drug payment changes across the country. In Phase 1, CMS recommends the replacement of ASP + 6% with a fixed percentage of 2.5% and a flat fee of .80 per drug per day administered. When sequestration is applied, the effective payment rate would be ASP + 0.86% plus .80 per drug per day. In Phase 2, CMS proposes to implement value-based payment approaches, such as indication-based pricing, reference pricing, and use of clinical decision support tools. The demonstration would be administered through the Center for Medicare and Medicaid Innovation, with Phase 1 scheduled to begin this fall.

IPN objects to CMS' proposed Part B Drug Payment Model demonstration as we fear it would lead to inadequate care for Medicare beneficiaries. Rest assured that IPN, Besse Medical, and AmerisourceBergen Corporation are already in action, collaborating with industry partners and advocating on your behalf in Washington, DC to put a halt to this demonstration. We believe we can make a difference and stop this proposal, but only with your involvement; this must be a collaborative initiative. In order to get the attention of lawmakers, and of CMS, you and your patients must immediately speak out against this harmful proposal.

To that end, there are a number of simple things that you can do to proactively influence this policy:

  • CMS has allowed for a 60 day comment period on the Part B Drug Payment Model. Please take advantage of this comment period by voicing your concerns over the demonstration on the CMS website at:

  • Get your practice involved. Through Community Counts, IPN has created a webpage from which you can easily send a letter to your local legislators urging them to ask CMS to halt the demonstration. The form letter is already written, and you can send as is, or edit as you see fit. Visit to send this letter to your lawmakers.

  • Get your patients involved. Your patients' voices can be stronger than your own. It is critical that Washington hears from the people who this demonstration will most deeply affect. IPN has also created a form letter for your patients on the Community Counts website, as well as talking points and documents that you can use to communicate about the proposed rule. Your patients can edit or send as is from here:

In addition, IPN will be hosting an informative Webinar on Friday, March 25, at 2pm central time. This web cast will:

  • Discuss the impact that the proposed demonstration would have on your practice

  • Demonstrate a tool for you to calculate the impact of Phase I of the demo for your practice

  • Detail the advocacy vehicles at your disposal.

You can register for this webcast here:

The importance of the proposed Part B Payment Model cannot be overstated; it is the biggest change in Medicare drug reimbursement in years. Several groups and publications have already raised concern over the effect this ruling would have on specialty care, but none of us can afford to remain silent. Through collaborative, consistent, and diligent work, we can make a difference and keep care in the community setting. We're committed to your continued mission of providing optimal patient care.

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