Medicare’s Flawed Part B Drug Experiment Could Harm Patients

Some of the most common health conditions affecting seniors today remain some of the most complicated to treat. While advances in medicine have given us greater understanding about cancers, and conditions like macular degeneration, hypertension, rheumatoid arthritis, and primary immunodeficiency diseases, effectively managing these illnesses and their symptoms often requires a significant amount of trial and error.

Even though physicians know which medications and treatments typically offer the best outcomes for any given disease, the reality is that patients respond differently. What worked for one might, unpredictably, fail for another. The best hope for patients is the flexibility to change course when appropriate, and ready access to the prescription drugs and biologics developed to combat these complicated conditions.

Unfortunately, access to these lifesaving therapies could soon suffer at the hands of a Centers for Medicare & Medicaid Services’s (CMS) initiative that focuses on costs rather than patients and health care quality.  Last month, CMS released an ill-conceived proposal to test new payment models for Medicare Part B prescription drugs that many patients are concerned will negatively impact care.

I remain highly concerned that CMS’s proposal uses a cookie-cutter approach that fails to recognize the individual patient needs of America’s diverse Medicare population.  Furthermore, by limiting access to prescription drugs and therapies, CMS is wedging itself between the patient and his or her physician – the only two individuals who should be making decisions about a patient’s course of care.

For Medicare patients, the impacts of CMS’s experiment could be dire. Reducing reimbursement to patients’ physicians to the level proposed would make it impossible for many providers to offer the most clinically effective treatment options to patients – forcing patients to forego prescribed therapies, or seek treatment in more expensive settings that increase costs to both patients and payers.

Further, there is absolutely no evidence that CMS’s proposed changes would improve quality of care for Medicare beneficiaries.  In fact, I am highly concerned that these changes will adversely impact patients that lose access to the most appropriate and clinically effective treatments for their conditions, jeopardizing patient health and increasing risks for adverse effects and declines in health that will cost the system much more money over time.

Equally as troubling is the fact that CMS completely excluded patient advocates from the process they used to develop this payment model.  There is a critical need for transparency, which was somehow lost in this exercise.  We oppose any effort to expedite reforms that failed to engage the broader Medicare patient community, and which we warn will negatively impact patient access to life-saving and life-extending drugs.

CMS should consider what’s best for patients and for Medicare. The advances in treatment that have been made possible over the years simply can’t fail because of poor policies that don’t support their use. It’s time for CMS to stop this experiment and carefully consider the best interests of our nation’s Medicare patients.

Rose Gerber is director of patient advocacy and education at the Community Oncology Alliance (COA) and leads the COA Patient Advocacy Network (CPAN), a national network representing all members of the cancer community and advocating for access to local, affordable cancer care.