Part B drugs administered in the physician’s office are generally reimbursed at average sales price (ASP) plus 6%, a rate set in statute by the Medicare Modernization Act of 2003 (MMA). However, the Budget Control Act of 2011 put a 2% sequestration on the federal budget, effective April 1, 2013, and extended numerous times after, most recently in the Bipartisan Budget Act of 2018. This has the effect of lowering Part B drug reimbursement to ASP + 4.3%.
COA filed ain the United States District Court for the District of Columbia seeking a permanent injunction against the 2% budget sequestration as it is applied to Part B drugs.
“We are filing to see an injunction against the United States Department of Health and Human Services and the Office of Management and Budget [OMB] because we have exhausted all possibilities in stopping what is an unconstitutional application of the 2% sequester cut to Part B drug reimbursement,” COA President Jeff Vacirca, MD, and Executive Director Ted Okon said.
May 30to HHS Secretary Alex Azar alerting him to the legal action, which was filed on May 31.
This Week's Must Reads
Gene sequencing sheds light on outcomes in MPN, Grinfeld J et al. N Engl J Med. 2018;379:1416-30
Obesity lowers risk of death in PE patients, Khan Z et al. CHEST. 2018 Oct. doi: 10.1016/j.chest.2018.08.919
DOACs perform well in real-world AF study, ESC CONGRESS 2018
T cell infusion effective in PML, Muftuoglu M et al. N Engl J Med. 2018 Oct 11;379:1443-51
Post hoc analysis of SUSTAIN shows efficacy of crizanlizumab, Kutlar A et al. Am J Hematol. 2018 Oct 8. doi: 10.1002/ajh.25308
Must Reads in Business of Medicine
For lymphoma patients, insurance is a matter of life or death , Goldstein JS et al. Blood. 2018 Jul 24. doi: 10.1182/blood-2018-03-839035
Concerns rise over proposal by CMS to level E/M payments , CMS proposed rule, CMS-1693-P
Expansion in clinical trial eligibility requested by ASCO, Friends of Cancer and ASCO letter to the FDA
CMS wants to flatten E/M payments, CMS proposed rule, CMS-1693-P
Lay health workers can assist with end-of-life care, Patel MI et al. JAMA Oncology. 2018 Jul 26. doi: 10.1001/jamaoncol.2018.2446.