Paying For New Cancer Drugs In Medicare Bundling Pilot Poses Challenge
One solution might be to provide transitional add-on payments for a limited period of time, as CMS has done in other Medicare payment programs.
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‘Episode of care’ payment model could reduce off-label cancer drug prescribing but also offers an opportunity for increased use of high-value drugs, including those that can reduce costs by decreasing hospitalizations, University of Chicago’s Rena Conti suggests.
Stakeholders differ on whether the rapid growth in spending is to be expected, given the realities in health care and specialty drug costs, or that the data underscores the need for oversight and reform of the 340B program.
The other seven drugs on the initial list for negotiation are already heavily rebated and CMS could choose not to go much lower than current net prices, SSR Health report points out.