Medicare’s Part B demo defeated but requires vigilance
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As President-elect Trump continues to assemble his cabinet and designate key posts at the Department of Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS), patient advocates must remain vigilant and poised to protect access to life-saving medicines.

For the past several months Patients for Medicare Access fought on behalf of patients to delay a CMS proposed pricing model for Medicare Part B. The proposal, while well intentioned, is bad for patients from the outset. If implemented, it would have mandated that patients use lower-cost drugs for their treatment regimens regardless of whether their health care provider recommended a more effective, but perhaps costlier, drug to manage their health condition.


The result could have been a catastrophic setback for thousands of Americans requiring ongoing treatments in specialty areas like cancer, rheumatology and renal care.

So many of us can relate to the devastation and emotional impacts of seeing a family member, friend or colleague suffer from diseases and chronic conditions. Intuitively we know a “trial-and-error” process for implementing a drug treatment regimen is counterproductive and insensitive.

Patients from across America needed a voice in Washington, and Patients for Medicare Access heeded their call. Assembling a broad coalition of providers, caregivers and patient advocates, together we appealed to our elected officials with indisputable facts and personal stories that demonstrated just how invasive, unnecessary, and damaging a “one size fits all” approach is be for patients.

Today, and for now, we can safely announce victory. The Part B demo, for all intents and purposes, has been defeated.

A victory of this kind should be accompanied with caution and vigilance however. Patient advocates mustn’t succumb to the warmth of complacency.

We should be encouraged by President-elect Trump’s selection of Representative Tom Price (R-Ga.) and Seem Verma to head HHS and CMS respectively. Both show strong inclinations to take a well-balanced, patient-centric approach to health care policy. Mr.  Price and Mr. Verma have a long history in health care policy and offer Medicare Part B beneficiaries a healthy appreciation of and respect for the patient-provider relationship, not to mention on-record opposition to mandatory value-based pricing models.

Looking ahead with a renewed sense of optimism means we must continue to encourage, and when necessary, implore Congress to act swiftly to ensure Medicare’s solvency, efficiency and service to every beneficiary. 

Regardless of our recent victory, we must be vigilant during the upcoming lame-duck Congress. With such a drastic shift in our political landscape, it is not unreasonable to expect a possible last-ditch effort to revive the Part B pricing demo. Those that concocted this proposal still wear their blinders regarding the value of the provider-patient relationship.

So we will remain watchful and stand at the ready for action. If the political winds blow unfavorably and once again begin to undermine patient access to Medicare, we’ll be ready because we’re always looking out for patients.  

Paul Gileno is the Founder and President of the U.S. Pain Foundation. Gileno leads the Patients for Medicare Access campaign which is made possible through funding by UCB, Inc.

The views expressed by authors are their own and not the views of The Hill.