On November 15, 2017, a bipartisan bill was introduced in the U.S. House of Representatives aimed at preventing CMS from reducing reimbursement by nearly 30 percent for Medicare Part B drugs purchased by certain hospitals under the 340B Drug Pricing Program.
On November 1, 2017, CMS released its final rule updating the Medicare Hospital Outpatient Prospective Payment System (OPPS). The final rule included changes to the Medicare Part B reimbursement rate for separately payable, nonpass-through drugs purchased by hospitals covered under the 340B Program. Currently, CMS pays 340B-eligible hospitals the average sales price, plus six percent. Under the new rates scheduled to take effect January 1, 2018, CMS will pay 340B-participating hospitals under the OPPS the average sales price, minus 22.5 percent. This change is estimated to reduce reimbursement to safety net hospitals by $1.6 billion annually. The payment reduction will not apply to rural sole community hospitals, OPPS-excluded children’s hospitals, and OPPS-excluded cancer hospitals.
Following CMS’s original proposed to change in reimbursement for 340B drugs, members of Congress sent a bipartisan letter dated September 27, 2017 to CMS Administrator Seema Verma urging the administration to withdraw the proposal. Nevertheless, CMS went ahead with the proposed cuts. In response, on November 15, Rep. David McKinley (R-W.Va.) and Mike Thompson (D-Calif.) introduced H.R. 4392. As proposed, the three-page bill would block CMS’s revised reimbursement rate from taking effect and directs CMS to leave reimbursement rates as they currently stand.
In a press release regarding H.R. 4392, Thompson states that CMS’s final rule “dramatically undermines the ability of hospitals across the country to deliver care to our nation’s most vulnerable populations.” Further, Thompson expresses disappointment that that CMS did not listen to hospitals, nor a majority of members in the House and Senate, and “approved a rule that puts both hospitals and patients at risk,” and that “protecting access to prescription drugs for low income communities should be a priority.”
The text of proposed H.R. 4392 is available in its entirety here. The September 27 bipartisan letter from members of Congress to CMS is available here.
