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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

National Council Comments on Proposed Changes to Medicare Part B

May 12, 2016 | Medicare | Comments
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The National Council this week submitted comments to the Centers for Medicare and Medicaid Services opposing the agency’s proposed change to drug pricing in the Part B program, noting the detrimental effect it could have on patients’ access to medications.

The CMS proposal would alter the current payment formula for drugs administered in physician and hospital practices, including medications such as long-acting injectables for the treatment of mental health or substance use conditions. The National Council is concerned about the potential impact of the new proposed payment model, which could disincentivize the use of these newer therapies even when clinically indicated for a patient’s care.

In our comments, the National Council asked CMS to add long-acting injectables for the treatment of mental illness and addiction to a list of drugs excluded from the new payment model. These drugs were deemed to be excluded based on concerns about limiting access to drugs that are not widely available or that are used for preventive purposes. Long-acting injectable medications fit both of these criteria: they prevent patients with a serious mental illness or addiction from experiencing a relapse of their condition; and they are not widely available to most patients despite their efficacy. Read our full comments here.

For more information on the Medicare Part B proposal and other recent federal actions that could pose barriers to patients’ access to medications, join us at Hill Day for the breakout session “New Treatments and Challenges to Access.” Register free today.