Tag Archives: Healthcare Insurance

Medicare Proposes New Pricing Plan For Part B Medications

Released on March 08, 2016


Medicare  proposed a new pricing plan for drugs administered in physician offices and hospital outpatient departments that would reduce an economic incentive to order a higher-priced drug when a less expensive one might work just as well, or better.

That incentive exists now because the Medicare Part B program pays providers the average sales price (ASP) of the drug, plus an extra 6% to cover handling and administration. That 6% margin translates into higher revenue as the price of a drug increases.

Under the proposed reimbursement model, Medicare Part B would pay the ASP, an add-on of only 2.5%, and a flat fee of $16.80 per drug per day, regardless of its price.

In a news conference today, a senior official in the Centers for Medicare and Medicaid Services (CMS) said that the new arrangement will prove liberating for many oncologists, who routinely administer chemotherapy drugs in their offices.

“We’ve heard from oncologists who feel pressure from their health systems to pick higher cost drugs when they’re not appropriate for their patients,” said Patrick Conway, MD, the chief medical officer at CMS and its deputy administrator for innovation and quality.

A report issued today by the Department of Health and Human Services (HHS) underscored the need to curb spending on Part B Medicare drugs.

The national tab for prescription drugs was $457 billion in 2015, or 16.7% of spending for all personal healthcare services, according to a report from the HHS Office of the Assistant Secretary for Planning and Evaluation. Of that amount, $128 billion, or 28.1%, went for non-retail drugs, which include chemotherapy, injectables, and eye care treatments administered in an outpatient setting.

The report puts the cumulative annual growth of prescription drug spending from 2013 to 2018 at 7.3% on average compared with an annual 5.2% increase in spending on all personal healthcare services. Price increases and a shift to prescribing more costly drugs in general account for about 30% of the overall growth of prescription spending, according to the HHS report.

Five-Year Study

CMS intends to introduce its new reimbursement framework for Part B drugs in select geographic regions late this year. In 2017, CMS will broaden its experiment by adding various pricing strategies now used in the private sector. These include discounting or eliminating patient cost-sharing, giving clinicians feedback on their prescribing decisions, and basing a drug’s price on its clinical effectiveness in treating different indications. CMS will compare the new model with the status quo in other geographic areas for 5 years.

The full proposal for reimbursement of Medicare Part B drugs was filed today on the Federal Register. CMS will accept comments on its proposal through May 9. The Federal Register document contains instructions on how to submit comments to CMS.

Additional information on the plan is available on the CMS website .


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C. difficile Infection (CDI) C Diff Foundation Opens a New Avenue – C. diff. Nationwide Community Support Program

The C Diff Foundation introduces the  C. diff. Nationwide Community Support (CDNCS) program beginning in November  for patients, families, survivors and for anyone seeking information and support.

C. difficile (C. diff.) infections caused almost half a million infections among patients in the United States in a single year, according to a 2015 study by the Centers for Disease Control and Prevention (CDC).

In addition, an estimated 15,000 deaths are directly attributable to C. difficile infections, making them a substantial cause of infectious disease death in the United States. [i].

As of 2015, there is an absence of professional C. diff. (CDI) support groups in America. The          C Diff Foundation has pioneered a collaborative plan and developed support groups in a variety of availability and locations to meet the needs of individuals seeking C. diff. information and support.

“We found it to be of the utmost importance to implement this new pathway for support and healing after speaking with numerous patients, family members, and fellow-C. diff. survivors,”

We now speak for the thousands of patients within the United States who, each year, are diagnosed with a C. diff. infection. This growth, in part, reflects the value C. diff. support groups will provide, not only to patients, their spouses, and families who are living with and recovering from a C. diff. infection, but also to the countless number of individuals who will become more aware of a C. diff. infection, the importance of early detection, appropriate treatments, and environmental safety protocols. There will also be Bereavement support group sessions for   C. diff. survivors mourning the loss of loved ones following their death from C. diff. infection involvement.

Beginning November 2015 the CDNCS groups will be available to all individuals via: Teleconferencing with some groups advancing and adding computer application programs in 2016. CDNCS groups will provide support and information  to 15 participants in each session.

The CDNCS program sessions will be hosted via: Teleconferencing with leaders hosting from Maryland, Florida, Missouri, Colorado, Ohio, and Oregon.

The Colorado CDNCS group is offered at a public venue and will be hosted in Arvada, Colo. every third Tuesday of each month, beginning November 17th. The Meeting will start at 5:30 p.m. and end at 7 p.m lead by a C Diff Foundation Volunteer Advocate and C. diff. survivor          Mr. Roy Poole.

To participate in any CDNCS group being offered during each month, all interested participants will be asked to register through the Nationwide Hot-Line (1-844-FOR-CDIF) or through the   website http://cdifffoundation.org/ where registered individuals will receive a reply e-mail containing support group access information.

  • The Support Registration Page  will be available on November 1st.

The C. diff. Nationwide Community Support group leaders will provide a menu of topics being shared each month on the C Diff Foundation’s website ranging from Financial Crisis Relief, Bereavement, Nutrition, Mental Health, to C. diff. infection updates and everyday life during and after being treated for a prolonged illness. Teleconference sessions will also host healthcare professional topic experts

There is evidence that people who attend support group meetings have a better understanding of the illness and their treatment choices. They also tend to experience less anxiety, develop a more positive outlook, and a better ability to cope and adapt to life during and after the treatment for C. diff.

There is a Purpose:

A diagnosis of a C. diff. infection is unexpected and almost always traumatic. As a result, it is not uncommon for newly diagnosed patients to experience a wide range of emotions including, confusion, bewilderment, anger, fear, panic, and denial. Many people find that just having an opportunity to talk with another person, who has experienced the same situation, to help alleviate some of the anxiety and distress they commonly experience.

Individuals also find that they benefit not only from the support they receive, but also from the sense of well-being they gain from helping others. It has been said “support is not something you do for others but rather something you do with others.”

“None of us can do this alone – all of us can do this together.”


Follow the C Diff Foundation on Twitter @cdiffFoundation #cdiff2015 and                                        Facebook https://www.facebook.com/CdiffFoundationRadio.

Note/citation: [i] http://www.cdc.gov/drugresistance/biggest_threats.html