Doctors in the dark on Medicare drug payment changes

The program is moving forward with one of four options, but which one?

By Markian Hawryluk, AMNews staff. Nov. 3, 2003.

Washington -- Despite commitments to improve the way it issues regulations, the Centers for Medicare & Medicaid Services plans to change the payment system for physician-administered prescription drugs under Medicare without letting doctors comment on the plan's final details.

In an effort to implement the payment reforms by Jan. 1, 2004, CMS in August issued a proposed rule outlining four approaches to change the payment system.

Although none of the four proposals was fully fleshed out in the rule, the agency indicated that it that would announce which option it had chosen in a final rule to be published in November.

Physician groups, including the American Medical Association, have urged CMS to delay implementation until affected parties can provide feedback on the reforms chosen.

"Without more detail, it is difficult to provide meaningful comments on all the options, and we therefore believe that physicians should have another opportunity to comment once CMS has chosen an alternative and worked out a more definitive plan for implementing this option," AMA Executive Vice President Michael D. Maves, MD, stated in a letter to the agency.

Physicians need sufficient lead time to adjust to the payment change because they order drugs months in advance, Dr. Maves wrote.

"At best, physicians would have a mere two months to determine whether their current acquisition cost exceeds Medicare's new price," he said. "They would then need to negotiate for lower prices, look for an alternative supplier or take cost-cutting steps to offset their losses."