On November 2-3, 2017, the Medicare Payment Advisory Commission (MedPAC) held a public meeting covering a variety of topics. Much of the discussion focused on an alternative to the Merit-based Incentive Payment System (MIPS), telehealth services, and biosimilars.
Continuing the discussion began at the previous public meeting, the Commission considered a possible alternative to MIPS. In their presentation, staff discussed a new voluntary value program in fee-for-service as a replacement for MIPS. This program would allow clinicians to elect to be measured as part of a voluntary group, which can then qualify for a value payment based on the group’s performance as determined using a set of population-based measures. Commissioners, questioning whether MIPS would accomplish stated goals, expressed conditional support for an alternative.
Some commissioners expressed concern about the size of the virtual groups, emphasizing that they not be too small. Others were concerned about the option of a fallback group for clinicians who don’t have a group to join but would like to be part of one. In addition, during this discussion, many commissioners expressed their support for Advanced Alternative Payment Models (A-APMs) and discussed a hope that MedPAC look for ways to encourage participation in these models. A draft recommendation related to an alternative to MIPS is expected in December.
The meeting also contained a session about biosimilars in the Medicare Part D program. This session follows MedPAC recommendations from June 2016. At this meeting, Commissioners were presented the following draft recommendation:
The Congress should change Part D’s coverage-gap discount program to:
- Require manufacturers of biosimilar products pay the coverage-gap discount by including biosimilars in the definition of “applicable drugs,” and
- Exclude biosimilar manufacturers’ discounts in the coverage gap for enrollees’ true out-of-pocket spending.
Overall, the commissioners were supportive of the draft recommendation. Commissioners highlighted the large impact that biologics and biosimilars can have, but noted that there are limitations in this space related to uptake, pricing, and competition. Commissioners expressed concern over activity that arises when biologics manufacturers look to delay the arrival of a biosimilar, include actions that result in legal settlements. Additionally, multiple commissioners framed this discussion as part of a larger conversation about drug pricing. These commissioners expressed a hope that MedPAC further explore drug pricing within its Medicare-focused purview. A final recommendation related to biosimilars is expected to be voted on at the January meeting.
Other sessions at the meeting focused on telehealth services; durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS); and primary care services. However, no other draft recommendations were presented. As with previous meetings, commissioners expressed support for exploring telehealth services, particularly in the stroke and mental health spaces, but expressed caution over just simply declaring it part of Medicare Part A and Part B. The 21st Century Cures Act mandated that MedPAC report on telehealth services. Additionally, when discussing DMEPOS, multiple commissioners were supportive of exploring reducing the number of products that are excluded from the competitive bidding process.
The November meeting also marked the final meeting for Mark Miller, the executive director of the Commission who has been with MedPAC for 15 years. Chairman Jay Crosson thanked Mr. Miller for his service at the end of the meeting. The next public meeting is scheduled for December 7-8, 2017.