CMS Proposes Harmful Medicare Part B Payment “Demo”

May 9, 2016

In March, the Centers for Medicare & Medicaid (CMS) released a proposed rule that would make extensive changes to the reimbursement of drugs covered under Medicare Part B.  A recent Avalere study showed that the proposed Part B demonstration would hurt doctors who utilize more expensive drugs in their treatment of patients, including specialties like ophthalmologists, oncologists and rheumatologists.

CLSA has very serious concerns regarding the impact this rule will have on patient access to important medical treatments and is on-record as opposing the proposed rule and calling for its full withdrawal.  Last month, CLSA joined 315 other healthcare and patient advocacy groups in expressing objections to the rule and calling for its repeal in a letter addressed to House and Senate leadership. Last month, several California-based patient and provider groups also expressed their concerns in a letter to members of our state’s delegation.

In an effort to halt the implementation of this harmful proposal, Representatives Charles Boustany (R-La.), Tom Price (R-Ga.) and John Shimkus (R-Ill.), recently led a letter asking CMS to withdraw the flawed policy. CLSA was very supportive of this letter, and encouraged Republican members of the California delegation to sign the letter. Ultimately, 242 members signed the letter to CMS, including 12 Republican members of the California congressional delegation: Reps. Ken Calvert (R-Corona), Paul Cook (R-Apple Valley), Jeff Denham (R-Modesto), Duncan Hunter (R-El Cajon), Darrell Issa (R-Vista), Steve Knight (R-Simi Valley), Doug LaMalfa (R-Redding), Tom McClintock (R-Roseville), Devin Nunes (R-Clovis), Ed Royce (R-Brea), David Valadao (R-Bakersfield), and Mimi Walters (R-Irvine). The only California Republican who did not sign the letter was Rep. Dana Rohrabacher (R-Costa Mesa).

The letter is available here.  Similar letters are being circulated on the House Democratic side and in the Senate, voicing strong concerns over the proposal, although they have not yet been finalized.

CLSA also developed and submitted comments opposing the proposal, focusing on the detrimental impact of the policy on California innovators and patients, and urging for its full withdrawal. Joining CLSA as signatories to the comments were Biocom, SoCalBio and Connect.

For questions, please contact Jenny Carey, CLSA’s Vice President of Federal Government Relations and Alliance Development (