Download the white paper.

The Inflation Reduction Act introduced several additional drug pricing reforms, including the Medicare Drug Price Negotiation Program (MDPNP), which authorizes the Centers for Medicare & Medicaid Services to negotiate prices for certain high-spend drugs covered by Medicare. Following the implementation of the MDPNP, an Avalere Health analysis estimated that add-on payments to physicians could be reduced by up to 50% for the 10 Part B drugs expected to be negotiated first.

Avalere Health conducted a provider survey to assess how this confluence of changes might affect clinical decision-making and practice economics for Part B providers.

We found that overall, providers anticipate that the MDPNP may heighten existing financial pressures, particularly for practices focused on infusion services in community settings. Respondents identified provider sustainability and patient access as key issues.

Key Findings: Respondents anticipate that Medicare drug price negotiations for Part B drugs will negatively affect provider reimbursement rates, add-on payments, administrative burden, and prescribing autonomy.

• 92% providers would be somewhat or very likely to stop stocking Part B drugs that are subject to negotiation.
• 79% of providers anticipate a moderate or severe impact to patient access to Part B drugs due to reimbursement cuts.
• 98% of providers believe that average sales price reductions due to Part B negotiations will interfere with physician-patient decision making.
• 68% of providers are moderately or severely concerned that reimbursement cuts for Part B drugs in Medicare will lead to negative treatment outcomes for their patients.

These changes, in turn, may impact both provider sustainability and patients’ access to treatment, and indicate an opportunity for further refinement of Part B Maximum Fair Price implementation to ensure practice viability and avoid downstream effects on patient access and continuity of care

Download the white paper.

 Funding for this research was provided by National Infusion Center Association. Avalere Health retained full editorial control.