The Trump administration is being warned by experts in the healthcare industry that its proposal to move over some drugs covered by Medicare Part B to Part D would negatively impact care quality and provider reimbursement.
In its efforts to lower the cost of drugs, policymakers made a promise to take a closer look at which Medicare Part B drugs could be negotiated for a lower price by Part D plans. Part B drugs largely consist of medications administered by physicians. This transfer is intended to cut down on incentives to deliver the Part B drugs in the priciest setting.
The proposed move could affect providers in regards to revenue and the role they play in physician-administered drug purchasing, storing, and billing. It may also result in unintentional patient access barriers resulting from differences in payment, cost-sharing, reimbursement, and settings of care in Part B and Part D.
With Medicare Part B, providers administer the drug and a claim is then submitted to the Medicare Administrative Contractor for reimbursement that covers both the medication and its administration. Prescription Drug Plans in the Part D program, on the other hand, typically contract with pharmacies to provide the medications directly to a consumer. These differences in how Medicare pays for prescription drugs could create problems for providers administering Part D-covered drugs.
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