Controlling Part B Drug Costs
The Academy has been in close communication with Centers for Medicare & Medicaid Services Administrator Seema Verma and other health policy officials since the Trump Administration first proposed lowering drug prices in 2017. The Academy supports the goal of lowering drug costs. But our core beliefs remain unchanged: ophthalmologists want patients to have timely access to the treatments they need. We also need the flexibility to provide our patients with access to necessary care. To date, we’ve met with officials at the U.S. Department of Health and Human Services (HHS) and CMS to discuss our concerns, and submitted numerous comments to rules, requests for information, and other regulatory activities that have stemmed from the original Trump Drug Pricing Blueprint released in 2017.
2020 Presidential Executive Orders
One area the Academy is paying close attention to is how the administration addresses Part B drugs. In July 2020, the president signed three executive orders to lower drug prices. President Trump also signed a fourth executive order on Medicare Part B drug prices after signaling he was tired of waiting for alternatives from pharmaceutical companies.
The fourth executive order (most-favored-nation) would tie Medicare Part B payment rates to prices paid in other countries. The models for both Medicare programs (Part B and D) would test whether paying no more than the most-favored-nation price would mitigate poor clinical outcomes and increased expenditures associated with high drug costs for patients who require pharmaceutical treatment. There still are very limited details about how the Administration will implement these Medicare demonstrations. A Centers for Medicare & Medicaid Services Innovation Center demonstration scenario could bypass what is normally a months-long process of public rulemaking and potentially allow the most-favored-nation price demonstrations to begin before election day.
Step Therapy
The Academy, along with many of our subspecialty organizations, continues to advocate with Medicare and commercial payers that “fail first” requirements inappropriately deny Medicare beneficiaries access to Part B treatments, delay access to necessary care, and will interfere with patient/physician decision-making.