Reports

Part B Payment for Medicare Drugs

A new analysis sheds light on why proposed changes to the system are being met with opposition and what they could mean for providers and patients.
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Authors

Peter B. Bach, MD, MAPP

Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center

Raina Jain

Research Data Analyst, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center

Stephen M. Schleicher, MD

Medical Oncology Fellow, Memorial Sloan Kettering Cancer Center

Coral L. Atoria, MS

Originally published on 04/11/2016

The Centers for Medicare and Medicaid Services (CMS) recently proposed a pilot program that targets the mark-up of Part B drugs.

This report examines implications of the proposed payment formula change and focuses on drugs used in cancer care.

Please find Dr. Bach's study here.

Four issues are addressed:

  1. Are there clinical situations in oncology where clinicians can choose between more and less expensive drugs and thus a change in the profit formula might encourage more cost-effective treatment?
  2. What is the total profit for doctors and hospitals for Part B drugs across their patients with varying types of insurance?
  3. Which drugs are favored versus disfavored by the change in the profit formula?
  4. How do the ‘ups’ and ‘downs’ affect the bottom line of doctors treating cancer patients? Do they end up ahead or behind?

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Authors

Peter B. Bach, MD, MAPP

Director, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center

Raina Jain

Research Data Analyst, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center

Stephen M. Schleicher, MD

Medical Oncology Fellow, Memorial Sloan Kettering Cancer Center

Coral L. Atoria, MS

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