More than 300 Stakeholder Groups Call on Congress to Block Proposed IPI Model

Yesterday, 339 patient, provider, and caregiver groups, on behalf of the Part B Access for Seniors and Physicians Coalition (ASP Coalition), sent a letter to Congress encouraging lawmakers to block the implementation of the International Pricing Index (IPI) model that was announced last month.

The letter, addressed to Senate Majority Leader Mitch McConnell, R-Kentucky, Senate Minority Leader Chuck Schumer, D-New York, House Speaker Paul Ryan, R-Wisconsin, and House Minority Leader Nancy Pelosi, D-California, explained that the groups “support efforts to strengthen the United States’ healthcare system through patient-centered reforms that embrace competition, foster the provider-patient relationship, and value transformation.” According to the groups, which include the Association of Community Cancer Centers, the Coalition of State Rheumatology Organizations, the Community Oncology Alliance, and the Global Healthy Living Foundation, the IPI is not aligned with those principles.

The IPI proposal would allow CMS to implement its reference price structure over a 5-year period, from 2020-2025, which would allow Medicare to more closely align its payment amount for selected Part B drugs with prices paid in other nations, as well as allow for the private-sector negotiations of drugs. CMS believes that the proposal could generate 30% in cost savings, though this figure does not take into account the prices of biosimilars; instead, it only compares the prices of reference products.

“Our greatest concern is that this model would impose decisions made in countries such as Greece or Japan on approximately half of all independent physicians and hospital providers, as well as their patients,” read the letter. “Compounding these concerns, the model also interjects new middlemen between physicians and patients—vendors that would impose requirements dictating treatment for patients with cancer, autoimmune disorders, and other complex, life-threatening conditions.”

The groups went on to warn Congress that this pricing model sets a risky precedent for other healthcare providers and services, because once Medicare takes on foreign price controls, CMS could then apply the same principles to other services. The letter also takes issue with the fact that the proposed model would enlist vendors with little to no clinical or medical expertise as the middlemen between patients and doctors.

“We support use of the Center for Medicare and Medicaid Innovation to test patient-centered, voluntary, small-scale reforms that can be fully evaluated. However, the IPI model is a wide-scale demonstration that would be mandatory, affecting 50% of physicians and hospitals serving Medicare Part B beneficiaries,” read the letter.

The groups emphasized that there are currently over 59 million seniors and persons with disabilities who rely on Medicare Part B for essential treatments. Due to this fact, any changes should be tested in a limited and thoughtful way, “based on clinical evidence and guidelines focused on high-quality care.” In closing, the letter urged Congress to work with the 339 organizations to help seek workable solutions focused on patients and providers.

CMS will continue to take comments on the IPI model until December 31, 2018.