The Alliance for Patient Access commissioned Apteka LLC to release a new issue brief highlighting the unintended consequences of Medicare negotiations, particularly related to Medicare Part B. This brief is the first in the series for AfPA highlighting the importance of keeping patient access at the forefront of health policy reform conversations.
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The brief highlights concerns that the next round of negotiations under the Inflation Reduction Act may unintentionally restrict access to vital medications for Medicare patients. The Centers for Medicare & Medicaid Services' upcoming drug price negotiation program, which includes medications covered by Medicare Part B, would take effect in 2028.
Starting next year, CMS will negotiate “maximum fair prices,” or MFPs, for select Part B drugs and reimburse clinicians based on those prices. While the goal of lowering patients' drug prices is broadly supported, the Part B negotiations could have unintended effects on patient access, especially for people with cancer, autoimmune disorders and other chronic illnesses.
Government-negotiated prices may leave providers unable to cover drug acquisition and care delivery costs, particularly for small and rural practices. A recent Avalere analysis projects a loss of at least $25 billion in provider add-on payments under the new model. The reduced margins may force some providers to stop offering these medications, shift patients to more expensive hospital settings, or close their doors altogether.
“Patients could face farther travel, increased prices, or go without essential treatments,” said Josie Cooper, Alliance for Patient Access Executive Director. “This threatens timely access to care and may reduce patient choice across the country.”
The transition to MFP-based reimbursement for Part B treatments also introduces complex billing and data exchange challenges, further burdening clinicians who are already struggling to stay afloat. Independent pharmacies have already reported concerns about delays and financial instability under the similar Part D changes, foreshadowing what could come for clinician-administered drugs.
AfPA calls for greater transparency, stakeholder engagement and flexibility from CMS as the program is implemented. Without careful attention to unintended consequences, patients may be the ones who bear the cost of reform.
About the Alliance for Patient Access
The Alliance for Patient Access is a network of policy-minded health care clinicians who advocate for patient-centered care.
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SOURCE Alliance for Patient Access
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