What can be done?
The problem could have been avoided, the authors wrote in their commentary, if payments had simply been adjusted for the two pre-2017 most highly overpaid DME-infused drugs, milrinone lactate and immune globulin, rather than all of them. Doing that would have addressed 95% of the overpayments and saved $267 million without affecting insulin cost.
Unlike insulin, nearly all of the other infused drugs are used only for short periods of time, such as pain medications, antibiotics, or chemotherapy.
“People get these for a few months, but not for years and years. Some aren’t used much at all. It was sort of a wholesale way to change things, and insulin got caught in it, with more extensive consequences,” Dr. Vigersky noted.
He and his coauthors advised the CMS to test pricing methodologies before implementation to prevent further unintended consequences going forward, to ask the Inspector General’s office to reanalyze costs to see if savings targets are being met, and to notify patients and health care providers in advance of a change so that they can better prepare for increased costs.
For now, Dr. Vigersky advised that, when considering pump therapy for a given patient, “from a clinical standpoint, this is a shared decision with the patient.
“As much as the reality of costs is shared with the patient, there is good evidence that pump therapy is cost-effective. The patient has to make the decision as to whether this extra amount is worth the benefits in the long run that they will get from pump therapy.”
A version of this article was originally published on Medscape.com.