Medicare Oncology Payment Program Could Pressure Part D Prices, Industry Says

A new Oncology Payment Model for Medicare will test episode-of-care payment for chemotherapy and offer incentives for keeping costs low, but biopharma firms are concerned that inclusion of Part D-covered cancer drugs in the cost measurement will intensify pressure on prices.

CMS’ new Oncology Payment Model will test an episode-of-care payment approach for chemotherapy and related services covered under Medicare Parts A and B in an effort to improve quality and lower costs, but its inclusion of Part D-covered cancer drugs in the cost measurement has raised concerns among pharmaceutical manufacturers.

Announced Feb. 12, the Oncology Payment Model was developed by the CMS Center for Medicare and Medicaid Innovation (CMMI). It...

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