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Medicare Tackles Drug Costs

Changes to Medicare Part B are scheduled to take place this fall. (V. Carter)
Changes to Medicare Part B are scheduled to take place this fall. (V. Carter)
October 20, 2016

SPRINGFIELD, Ill. — Changes to the Medicare Part B program, called the Medicare Part B Drug Demo, are designed to lower the expenses connected with chemotherapy by cutting prescription drug costs and encouraging physicians to use cheaper alternatives.

Dr. Blase Polite, chairman of the American Society of Clinical Oncology’s Government Relations Committee, said the plan could have negative consequences because some patients don't have alternatives; they need a particular drug at a particular time to effectively treat their cancer. He said that the plan is essentially a trimming back of Medicare coverage, which could hurt doctors and patients by cutting reimbursement costs.

"Not just the cancer doctors, but the eye doctors for people who have macular degeneration, the people with bowel disease going to the gastroenterologist, the rheumatologist, people with rheumatoid arthritis,” Polite said; "all those folks are going to lose out under this thing."

The plan has garnered support from AARP and the Medicare Rights Center, who said taxpayers and Medicare recipients can't continue to pay for overpriced prescription drugs. According to AARP, in 2015 Medicare Part B spent $22 billion on prescription drugs, double the amount spent in 2007.

Polite said that the goal of the changes is to lower drug prices, but cutting reimbursements to doctors could force them into making impossible choices.

"We're going to give the medicine; that's what we do,” Polite said. "So either we have to figure out a way to give the medicine somewhere else - and that means hospitals that can probably absorb the cost cut a little bit better - or I'm going to have to take it out of services for other patients. And no way do we see that this is actually going to help drug prices."

Currently, Medicare Part B pays providers based on a drug's average price plus an additional 6 percent. The proposed change would adjust the reimbursement to 2.5 percent plus a flat fee.

Advocates have called it a thoughtful, measured approach to modernizing the way in which Medicare pays for expensive drugs. But Polite said he believes it will disproportionately hurt doctors with small offices. He said Congress can block the implementation of the changes. Polite urges voters to contact their local lawmakers to voice their concerns about the issue.

Veronica Carter, Public News Service - IL