CMS Cancels Medicare Part B Demonstration Project

When the controversial Medicare Part B Drug Payment Model final rule was not released by the Centers for Medicare & Medicaid Services (CMS) as expected before Nov. 21, it signaled an increasing likelihood of defeat for the proposed rule—a signal proved true on Dec. 15.

A spokesperson for the CMS said, “After considering comments, CMS will not finalize the Medicare Part B Drug Payment Model during this administration. The proposal was intended to test whether alternative drug payment structures would improve the quality of patient care and the value of Medicare drug spending. While there was a great deal of support from some, a number of stakeholders expressed strong concerns about the model. While CMS was working to address these concerns, the complexity of the issues and the limited time available led to the decision not to finalize the rule at this time.”

From the time it was released in March 2016, the ACR  voiced strong opposition to the proposal. The ACR submitted detailed comments to the CMS in response to the proposed rule, and our members and patients sent more than 4,800 emails to Congressional offices, educating legislators about the negative impact this proposal would have on rheumatology patients who rely on physician-administered biologic therapies.

We want to extend a special thank you to the ACR/ARHP members and patient advocates who came to Washington, D.C., to meet with members of Congress and underscore the disproportionate impact the Part B payment model would have on rheumatology providers and patients. Working with our partners, our collective outreach to Congress resulted in 389 lawmakers writing to the CMS to express concern about the proposed rule.

In addition to Congressional outreach, ACR members and patients published more than 50 opinion pieces and letters to the editor in leading publications throughout the country, including The Wall Street Journal, Los Angeles Times, MedPage Today and The Hill. The ACR also ran print and social media ads warning about the negative effect the rule would have on patient care.

The coordinated opposition from rheumatologists, patients and partnering organizations elevated this issue to the forefront of healthcare policy and led Senate Minority Leader Chuck Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) to formally request that the CMS not finalize the Part B Drug Payment Model. Nov. 21 marked the end of the 60-day hold period that would have allowed the rule to be released and implemented before the new administration takes control.