Medicare Part B: payments and use for selected new, high-cost drugs : report to Congressional Committees
- Collection:
- Health Policy and Services Research
- Contributor(s):
- United States. Government Accountability Office. issuing body. United States. Congress. issuing body.
- Publication:
- Washington, DC : United States Government Accountability Office, March 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Cost Control -- legislation & jurisprudence Government Regulation Legislation, Drug -- economics Medicare Part B -- economics United States
- Genre(s):
- Technical Report
- Abstract:
- Why GAO did this study. Medicare makes “pass-through” payments under Medicare Part B when hospital outpatient departments use certain new, high-cost drugs. These temporary payments are in addition to Medicare’s payments for the procedures using the drugs. They may help make the new drugs accessible for beneficiaries and also allow Medicare to collect information on the drugs’ use and costs. The Consolidated Appropriations Act, 2018 included a provision for GAO to review the effect of Medicare’s policy for packaging high-cost drugs after their pass-through payments have expired. This report describes (1) the payments associated with selected high-cost drugs when eligible for pass-through payments versus when packaged, and (2) hospitals’ use of those drugs when eligible for pass-through payments versus when packaged. GAO reviewed federal regulations on pass-through payments and Medicare payment files for all seven drugs whose pass-through payments expired in 2017 or 2018 and that were subsequently packaged. All of these drugs met Medicare’s definition for having a high cost relative to Medicare’s payment rate for the procedure using the drug. GAO also reviewed Medicare claims data on the use of the drugs for 2017 through 2019 (the most recent available). To supplement this information, GAO also interviewed Medicare officials, as well officials from 11 organizations representing hospitals, physicians, and drug manufacturers, about payment rates, use, reporting, and clinical context for the drugs.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (ii, 25 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918317781906676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918317781906676