The Centers for Medicare and Medicaid Services recently announced that they would be experimenting with how it pays for drugs covered by Medicare Part B. Part B pays for medications that are administered in a doctor’s office or at the outpatient department of a hospital. Medicare usually pays the doctor the drug’s average sales price plus 6%. However, this payment structure may serve as an incentive for physicians to choose higher-priced medications in order to receive a higher reimbursement.
Now, CMS will be testing a new payment model that will only reimburse physicians an additional 2.5%, plus a $16.80 flat fee. Other proposed changes include reducing patient cost shares and linking reimbursement to outcomes.
These findings were published in Kaiser Health News on March 9, 2016.