On Oct. 25, the Centers for Medicare and Medicaid Services (CMS) released an Advanced Notice of Potential Rulemaking (ANPRM) on a potential International Pricing Index (IPI) model for Medicare Part B drugs that would aim to preserve or enhance quality of care for beneficiaries while reducing expenditures for Medicare Part B drugs to more closely reflect international comparator countries.

Specifically, the agency intends to test whether phasing down the Medicare payment amount for selected Part B drugs to more closely align with international prices; allowing private-sector vendors to negotiate prices for drugs, take title to drugs, and compete for physician and hospital business; and changing the 4.3 percent (post-sequester) drug add-on payment in the model to reflect 6 percent of historical drug costs translated into a set payment amount, would increase the quality of beneficiary care and reduce unnecessary expenditures.

CMS envisions that the model would initially focus on single source drugs and biologicals, as they encompass a high percentage of Part B drug spending and are frequently used by physicians that bill under Medicare Part B. IPI Model participants would include physician practices and hospital outpatient departments that furnish the model’s included drugs in the selected model geographic areas. The agency is considering the inclusion of durable medical equipment suppliers, Ambulatory Surgical Centers or other Part B providers and suppliers that furnish the included drugs. According to CMS, the model would maintain beneficiaries’ choice of provider and treatments and would incorporate meaningful beneficiary protections such as enhanced monitoring and Medicare Beneficiary Ombudsman supports.

The potential IPI Model would start in spring 2020 and operate for five years. Over the course of the model, CMS would monitor and evaluate the model’s impact on beneficiary access to drugs, program costs and the quality of care for beneficiaries.

CMS is seeking public input on the ANPRM through comments. ACC Advocacy staff are actively reviewing the released ANPRM and will submit comments prior to the Dec. 31 deadline.  

Clinical Topics: Cardiovascular Care Team

Keywords: ACC Advocacy, Medicare Part B, Health Expenditures, Centers for Medicare and Medicaid Services, U.S., Drug Costs, Outpatients, Medicaid, Quality of Health Care

< Back to Listings