Editors' Commentary: Save the baby
Why biopharma should fight to create a true value-based experiment at CMS, not kill it
Biopharma industry associations, patient advocates and physician groups have joined forces to ask Congress to kill CMS's plan to test new schemes for reimbursing drugs administered in physician offices and hospital outpatient facilities. While the opponents raise valid points, their March 17 letter perpetuates erect-the-barricades thinking that is as obsolete as the outdated reimbursement methods the agency is trying to replace.
Even worse, the biopharma industry and its patient allies are failing to take up the opportunity to actually build a value-based reimbursement system. Instead, they are jumping into the middle of an intractable conflict over payments to providers.
The CMS proposal is not close to perfect. The first phase, slated to begin this fall, envisions a mandatory, nationwide experiment in modifying the ASP reimbursement formula for infused drugs. It could prevent some patients from accessing some drugs, and would likely shift care from private practices to hospitals, contributing to the concentration of care in ways that are more expensive to the government and less convenient for patients.
The second phase, which would not begin until January at the earliest, is described