A Dangerous Medicare Experiment

A Dangerous Medicare Experiment

By U.S. Rep. Buddy Carter (R-Georgia) –

The Center for Medicare and Medicaid Innovation (CMMI) within the Centers for Medicare and Medicaid Services (CMS) has proposed a dangerous experiment with Part B drug payments. Under the experiment, Medicare payments would be significantly below a physician’s acquisition costs for a drug. This will put patients at risk by potentially forcing them to abandon the best treatments for a cheaper, less effective alternative. Millions of Medicare patients depend on access to lifesaving treatments and this experiment will not only result in negative consequences for treatment, it is also the first step to government price controls.

It is not acceptable to allow CMS to create an end run around the doctor-patient relationship to dictate treatments. I have joined my colleagues in sending a letter to CMS expressing our concerns and I have cosponsored legislation to prohibit them from moving forward with this dangerous experiment.

The following are excerpts of an article I wrote for The Hill explaining my concerns with this proposal:

“This spring, I joined over 240 of my colleagues… with a sweeping, nationwide experiment that the Center for Medicare and Medicaid Innovation has proposed. After speaking with patients and physicians in my district, there is no uncertainty that the CMMI experiment with Part B drug payment is the first step to government price controls and it will have negative consequences for millions of Medicare patients who depend on access to lifesaving treatments.

“Many seniors … are faced with medically complex diagnoses including cancer, rheumatoid arthritis, severe immune deficiency, epilepsy and macular degeneration. After diagnosis, these Medicare patients face significant complexities in their care and treatment options. Under the Part B drug experiment, in many cases, Medicare payment for certain drugs would be significantly below a physician’s acquisition costs for the drug.

This will put patients at tremendous risk, potentially forcing them to abandon the best treatments for other treatments that have proven less successful. Ultimately, CMS will create an end run around the doctor-patient relationship to dictate treatments. This is unacceptable.

To make matters worse, CMS sought little to no stakeholder input and has provided little turnaround time before medication treatment will be based on cost rather than what is best for the patient. As a lifelong pharmacist, I trust clinically trained medical professionals to determine the best treatment for patients, not an unaccountable bureaucrat.

Adding to the outlandish nature of this Part B drug pilot project, there is nearly no escaping it. CMMI proposes to force nearly 75 percent of the country to participate in this experiment. Seventy-five percent of the country is not a pilot project; it is near full implementation of a new program.

CMS responded to the letter we sent them and simply thanked us for sharing our opinion. Such a brief and dismissive response is indifferent to the risks posed to our nation’s sickest patients and to Congress.

For all of these reasons, I have cosponsored H.R. 5122 introduced by Rep. Larry Bucshon (R-Ind.). This legislation would prohibit CMS from moving forward with this dangerous, misguided experiment with our seniors. This legislation is critical to ensure bureaucrats in Washington aren’t dictating treatment.

U.S. Rep. Buddy Carter represents the 1st Congressional (coastal) district of Georgia.