1 June 2016 - In phase I, scheduled for fall 2016, CMS will reimburse approximately half of U.S. physicians under the existing system at each drug’s average sales price plus 6%.

Physicians in the intervention group will receive average sales price (ASP) + 2.5%, plus $16.80 per drug per day. In phase II, planned for early 2017, physicians in both groups will be randomly assigned to receive reimbursement with or without additional value-based payment incentives. These may include reference-based pricing, which pegs reimbursement to the least expensive drug in a class; indication-based pricing linking reimbursement to magnitude of expected benefit; outcome-based risk sharing linking reimbursement to realized clinical benefit; and tiered patient copayments.

The greatest effect will be on oncologist–hematologists, who account for 23% of Part B drug spending, followed by ophthalmologists (11%), rheumatologists (5%), and primary care physicians (5%). Part B drug spending increased from $9.4 billion in 2005 to $18.5 billion in 2014, with 20 drugs accounting for 57% of the 2014 total. The top 20 drugs include 11 for cancer; 3 for macular degeneration; 2 for hematopoietic growth factors; 2 for rheumatoid arthritis (1 of which is also used for cancer); and 1 each for multiple sclerosis, ulcerative colitis, and osteoporosis. For 13 of these 20, mean annual per-patient reimbursement exceeded $10,000.

For more details, go to: http://www.nejm.org/doi/full/10.1056/NEJMp1603735?query=TOC