Been warning about this from the very beginning, and now it’s starting in earnest: Cost-centric strategies leaving patient-focused medicine in the dust.
Last week the Medicare Payment Advisory Commission met to consider recommendations that empower Medicare to reinstate the option to base Part B drug reimbursement on the least costly alternative (LCA) among products.
Note please, that “least costly” in no way means “best for the patient.”
On October 7th, MedPAC heard two proposals outlined by commission staffer Nancy Ray.
The first was that Congress should give CMS authority to apply least costly alternative policies in setting payments for items and services covered under Medicare Parts A and B, and CMS should periodically assess the clinical similarity of Medicare-covered services and apply LCA policies for those services deemed clinically similar.
The second was that Congress should direct CMS to set the payment rate for a newly covered service that lacks evidence demonstrating better outcomes than existing treatment options at a level that is no higher than the LCA.
The policy could end up relying heavily on data from comparative effectiveness research conducted under the auspices of the Patient-Centered Outcomes Research Institute, which is being created under the Affordable Care Act.
A provision of the ACA states that HHS cannot deny coverage of items based solely on the results of comparative clinical effectiveness research, presenting a possible gray area should LCA determinations favor one product over another.
Ray predicted that both of the LCA recommendations would decrease spending relative to current law and also would lower beneficiary cost sharing in the short term and Medicare premiums in the long term.
While the commission did not vote on either recommendation, comments from members were generally supportive. Surprised?
If you needed another reason to understand why the upcoming elections are so crucial to 21st century patient care – you’re welcome.
