CMS Responds Disappointingly to Bipartisan Concerns with Harmful Medicare Part B Payment Policy

June 15, 2016

On May 31, Centers for Medicare and Medicaid Services’ (CMS) Acting Administrator Andrew Slavitt sent a response to the May 2, 2016 comment letter initiated by Representatives Tom Price (R-Ga.), Charles Boustany (R-La.), and John Shimkus (R-Ill.) regarding concerns with CMS’ proposed Part B Payment Model.

In a less than one-page response, CMS does not address any specific provisions of the Members’ initial comment letter. Instead, CMS broadly describes the proposed model itself, stating that it is designed to “drive the prescribing of the most effective drugs and test new payment approaches that reward positive patient outcomes.” CMS states that it “appreciates” the Members’ interest on this issue and that the agency will “work towards our mutual goal of strengthening the Medicare program for all beneficiaries.” CMS also notes that it will “carefully consider” all public comments in developing a final rule.  However, the agency does not provide any timeframe for issuing a final rule related to the Part B Payment Model. Slavitt’s letter to Rep. Price is available here.

In March, CMS released the controversial proposed rule that would make extensive changes to the reimbursement of covered drugs 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 life-saving treatments and is on-record as opposing the proposed rule and calling for its full withdrawal. CLSA joined 315 other health care and patient advocacy groups in expressing objections to the rule and calling for its repeal echoed these sentiments in a letter addressed to House and Senate leadership asking Congress to oppose these Part B cuts. Several California-based patient and provider groups also expressed their concerns in a letter to members of our state’s delegation.

The May 2 letter led by Reps. Price, Boustany, and Shimkus called for CMS to withdraw the proposed rule because it would “severely harm patient access to needed drugs.” CLSA was strongly supportive of this letter, and urged our delegation members to lend their support. Ultimately, this letter was supported by a total of 242 Members of the House of Representatives (238 Republicans, 4 Democrats), 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.) The final letter is available here.

In addition, Democrat-only letters were circulated in May and received a number of co-signers from the California congressional delegation. In particular, Reps. Pete Aguilar (D- Redlands), Ami Bera (D- Sacramento), Julia Brownley (D- Thousand Oaks), Tony Cárdenas (D-Van Nuys), Susan Davis (D- San Diego), Anna Eshoo (D- Silicon Valley), Sam Farr (D- Monterey), Mike Honda (D- Santa Clara), Zoe Lofgren (D- San Jose), Scott Peters (D- La Jolla), Raul Ruiz (D- Palm Desert), Linda Sánchez (D- Cerritos), Jackie Speier (D- Hillsborough), Eric Swalwell (D- Dublin), Mike Thompson (D- Napa), Norma Torres (D- Ontario) and Juan Vargas (D- Chula Vista) signed a letter let by Representative Neal (D-Mass.) expressing serious concerns regarding the proposal. That letter is available here. Another letter that expressed concerns on the Medicare payment policy, led by Representatives Robin Kelly (D-Ill.) and Terri Sewell (D-Ala.) was cosigned by Representatives Pete Aguilar (D- Redlands), Karen Bass (D- Los Angeles), Jim Costa (D- Fresno) and Norma Torres (D- Ontario). That letter is available here.

CLSA also led a set of comments for submission to CMS, focusing on the dangerous impact of this policy on California innovators and urging for its full withdrawal. Our colleagues at California regional associations, Biocom, CONNECT and SoCalBio, joined us as cosigners of the comments which are available here. CLSA will continue to advocate for withdrawal of this policy and urge our congressional delegation to do so as well. For questions, please contact Megan Drenan, CLSA’s Associate Director of Federal Government Relations (