May 8, 2019

Xcenda Releases Report on Current Medicare Part B Drug Pricing Proposals and Implications of the International Pricing Index (IPI) Model

In 2018, the Trump Administration released a proposal that would implement price controls in Medicare Part B reimbursement for physician-administered drugs based on international prices. The Part B Access for Seniors and Physicians Coalition (ASP Coalition), in addition to other key policy stakeholders, responded to Congress and the Administration with their concerns about the IPI model and the implications for patients and providers. Xcenda, in partnership with the ASP Coalition, felt it was important to explore the implications of this wide-scale, unprecedented demonstration and the risks of moving forward with it.


Upending the Medicare Part B Program—The International Pricing Index (IPI) Proposed Model

The timely white paper, commissioned for the ASP Coalition, explores how the proposed International Pricing Index (IPI) Model would pose serious risks to Medicare beneficiaries, including treatment delays, limited access to treatments and providers  - all without necessarily sharing the cost-savings. 


As demonstrated in other Medicare Part B papers, Xcenda found that providers are not basing treatment decisions based on reimbursement so the question becomes what problem is trying to be solved and are the implications of this demonstration simply creating new problems that the system is ill-equipped to handle. Part B beneficiaries – who often have serious, complex conditions like cancer and rheumatoid arthritis – have the right to access treatments deemed clinically appropriate by their providers. Under the IPI model, vendors with no clinical expertise may have the power to impose restrictions on care and collect revenue as a new middleman in the system. Additionally, the IPI could have a significant impact on pharmaceutical research and development resulting in fewer new drugs for patients. 


The paper explores the implications of the model and poses the ultimate question – does the solution solve an existing problem or create new ones.