One portion of Medicare, Medicare Part B, provides access to personalized care under the supervision of a physician and coverage for medicines for some of the sickest and most vulnerable Medicare beneficiaries, including seniors with cancer, rheumatoid arthritis, Crohn’s and other autoimmune conditions, mental illness, eye diseases, and individuals with disabilities. The Part B Access for Seniors and Physicians Coalition is committed to ensuring continued access for this vulnerable population.
Exacerbate health care consolidation: As Medicare reimbursements for complex medicines have declined, a growing number of oncology practices have closed or consolidated with the local hospital. This makes care more expensive and less convenient for patients. Medicare policies should not further drive this consolidation.
Increase access restrictions: Patients should not face long travel times, higher out-of-pocket costs, or undue utilization management techniques in order to receive the therapies their physicians determine are most appropriate.
Decrease choice of therapy: The conditions treated by Part B therapies are incredibly complex. Seniors have often already tried several treatments before becoming stable on a particular therapy. The government should not come between doctors and their patients by restricting choice and driving one-size-fits all therapy decisions.
Stifle future innovation: Some of the most exciting new therapies in development are physician-administered treatments for cancer and other serious conditions that will be covered by Part B. Medicare policies should not hinder the development of new treatment advances that can extend life and improve quality of life for seniors.
In addition to providing coverage for physician office visits, outpatient services, and other routine care, Medicare Part B covers approximately 600 medicines, administered in hospital outpatient departments, in physician offices, in the home, or at dialysis centers. Because of the complexity of many Part B medicines and the special handling that is often required, health care providers purchase these medicines and store them at their practices until they are needed by a patient. When a patient receives treatment, Medicare then reimburses providers at a market-based rate. This rate is broadly recognized as providing a fair reimbursement to providers, who incur a number of overhead costs to maintain an inventory of these medicines. However, the reimbursement rate has been eroded overtime, and small and rural providers in particular may still struggle to purchase medicines at the Medicare rate.
Download information about Medicare Part B and how these proposed changes could negatively affect your family.
The Center for Healthcare Quality and Payment Reform, December 19, 2019
Inside Health Policy, December 10, 2018
STAT News, By Elizabeth Krempley, December 10, 2018
The Hill, By David I. Daikh and Ralph L. Sacco (op-ed), April 10, 2018
Inside Health Policy, By Michelle M. Stein , October 25, 2017
The Hill, By Sharad Lakhanpal, MBBS, MD (op-ed), June 26, 2017
Inside Health Policy, By John Wilkerson, May 19, 2017
Los Angeles Daily News, By Carolynn Martin (op-ed), April 21, 2017
Inside Health Policy, By John Wilkerson, April 13, 2017
Modern Healthcare, By Virgil Dickson, April 6, 2017
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