Oncology drugs biggest challenge, most affected under Medicare billing code proposal – experts

19 Jul 2016

Off-label prescribing and drugs used for multiple oncology indications will complicate efforts to consolidate billing codes under Medicare Part B per recommendations from a legislative-branch agency, experts said.

Under recommendations issued in a 15 June report by the Medicare Payment Advisory Commission (MedPAC), cancer drugs will be disproportionately affected by the consolidation, they explained. Nonetheless, other drugs covered under Part B for indications like autoimmune diseases, chronic obstructive pulmonary disease (COPD) and others will also be impacted, they noted.

The MedPAC report outlined ways to improve Medicare and payment systems, including a suggestion for stimulating price competition by consolidating Medicare Part B billing codes. The proposed consolidation is likely to face implementation challenges overall and backlash from the physician community as well as the drug industry, this news service reported 15 July. While the consolidation could drive price competition and lower prices, such benefits are still a long way away, it was reported.


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