MedPAC Suggests Expansion of DVP to Inpatient Setting

The Medicare Payment Advisory Committee (MedPAC), in its comments to CMS on the proposed 2019 Hospital Outpatient Prospective Payment System rule, suggests expansion of the proposed Drug Value Program (or, DVP, a revamped version of the agency's Competitive Acquisition Program) as a possible approach for "certain high-priced products regardless of the setting in which they are administered." Citing CAR T-cell therapy as an example, the commission's comment letter states:

"The recent development of CAR-T immunotherapy, which is extraordinarily expensive and can be furnished in inpatient and outpatient hospital settings, has drawn attention to the issue of very high cost drugs across settings. The DVP model, with its management tools such as a formulary and binding arbitration, may be well suited for addressing very high priced drugs across settings."

Association of Community Cancer Centers (ACCC) comments to the Drug Value Plan proposal included within the 2019 OPPS rule urge that:

"Any policy solution to rein in drug costs must preserve patients’ access to – and ability to afford – quality cancer care and, relatedly, mitigate any impact on already reduced payment rates for cancer care providers."

Further, ACCC requests that the agency ensure that any model based on Competitive Acquisition Program (CAP) authority is:

• voluntary for all participants,
• preserves patient access to treatment and provider flexibility, and
• promotes cost-efficiency through more effective distribution and delivery of drugs and biological rather than utilization management tools.

Read MedPAC comments to the proposed 2019 OPPS rule.

Read ACCC comments to the proposed 2019 OPPS rule.

MedPAC is an independent congressional agency established to advise the U.S. Congress on issues affected the Medicare program.

Posted 10/5/18