Medicare Part B Drug Reimbursement Proposal Would Cut Reimbursement for GI Practices and Infusion

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    Whitfield L. Knapple, MD, FACG Chair, ACG National Affairs

    Whitfield L. Knapple, MD, FACG
    Chair, ACG National Affairs

    This week, ACG submitted formal comments to CMS regarding an ill-advised proposal to change the reimbursement formula for physician-administered drugs, such as infliximab and vedolizumab.  ACG is also a member of like-minded coalitions of providers in opposition to this proposal.  Many patient advocacy groups, such as the Digestive Disease National Coalition (DDNC), also oppose this payment change.

    ACG is also engaged and working with allies in Congress by promoting a bill sponsored by Rep. Larry Buchson (R-IN).  This bill would prevent CMS from going through with this proposal.

    Background:

    Currently, Medicare reimbursement for drugs purchased by physicians is set at the Average Sales Price (ASP) +6 percent.  CMS is proposing a “demonstration project” or experiment where providers in some areas would be paid ASP+2.5 percent and a $16.80 flat fee.  These rates are further cut by an additional 2% due to congressional “budget sequestration” rules.

    The goal of “changing the prescriber’s behavior” as described in this proposal may have an unintended consequence in specialties with little to no alternatives in the first place, such as gastroenterology.  This lack of consideration for areas of patient care that have limited FDA-approved and therapeutically equivalent alternatives, but are still swallowed up in this monolithic experiment, remains a significant shortcoming of this proposal: GI medical practices (not drug manufacturers) will receive reduced payments when purchasing expensive but necessary drugs for our patients.

    ACG will continue to lead on policy issues solely impacting clinical GI.  When policy issues impact other specialties in addition to GI, however, ACG will work both independently as well as part of larger coalitions to help further our membership’s priorities.

    Whitfield L. Knapple, MD FACG

    Chair, ACG National Affairs Committee

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