Sec. 507. MedPAC report on shifting coverage of certain Medicare part B drugs to Medicare part D
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The Medicare Payment Advisory Commission (in this section referred to as the Commission ) shall conduct a study on shifting coverage of certain drugs and biologicals for which payment is currently made under part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395j et seq.) to part D of such title ( 42 U.S.C. 1395w–21 et seq.). Such study shall include an analysis of— differences in program structures and payment methods for drugs and biologicals covered under such parts B and D, including effects of such a shift on program spending, beneficiary cost-sharing liability, and utilization management techniques for such drugs and biologicals; and the feasibility and policy implications of shifting coverage of drugs and biologicals for which payment is currently made under such part B to such part D.
Not later than June 30, 2021, the Commission shall submit to Congress a report containing the results of the study conducted under subsection (a). The report under paragraph
(1)shall include information, and recommendations as the Commission deems appropriate, regarding— formulary design under such part D; the ability of the benefit structure under such part D to control total spending on drugs and biologicals for which payment is currently made under such part B; changes to the bid process under such part D, if any, that may be necessary to integrate coverage of such drugs and biologicals into such part D; any other changes to the program that Congress should consider in determining whether to shift coverage of such drugs and biologicals from such part B to such part D; and the feasibility and policy implications of creating a methodology to preserve the healthcare provider’s ability to take title of the drug, including a methodology under which— prescription drug plans negotiate reimbursement rates and other arrangements with drug manufacturers on behalf of a wholesaler; wholesalers purchase the drugs from the manufacturers at the negotiated rate and ship them through distributors to physicians to administer to patients; physicians and hospitals purchase the drug from the wholesaler via the distributor; after administering the drug, the physician submits a claim to the MAC for their drug administration fee; to be reimbursed for the purchase of the drug from the distributor, the physician furnishes the claim for the drug itself to the wholesaler and the wholesaler would refund the cost of the drug to the physician; and the wholesaler passes this claim to the PDP to receive reimbursement.
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- 42 USC 1395w–21
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Sec. 507
MedPAC report on shifting coverage of certain Medicare part B drugs to Medicare part D
Cite42 USC 1395w–21
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