On November 1, 2018, CMS finalized its rule for the 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP). In the final rule, CMS acknowledges responses to its comment solicitation in the proposed rule on creating a bundled episode of care for management and counseling treatment for substance use disorders. Additionally, CMS is implementing a provision from the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act through an interim final rule. The Final Rule also reduces wholesale acquisition cost (WAC)-based payment for newly-launched physician-administered drugs to 103% of WAC.
On October 30, 2018, CMS published an Advanced Notice of Proposed Rulemaking for a potential International Pricing Index (IPI) Model for Medicare Part B Drugs. The model would be phased in over a five-year period and will be tested as a pilot program through the CMS Center for Medicare and Medicaid Innovation. The model is intended to lower expenditures for Part B drugs by implementing an international reference price to shift payments to a level that is comparable with prices in other countries. It also seeks to reform the current “buy and bill” system for Part B drugs and alter reimbursement methodology to eliminate existing incentives to prescribe higher-cost drugs.
On October 18, 2018, CMS issued a new proposed rule that would require direct-to-consumer (DTC) television advertisements of prescription drugs and biological products payable by Medicare or Medicaid to include the wholesale acquisition cost (WAC), or list price, of that prescription drug or biological product.