Medicare Part B Drug Price Negotiations May Restrict Patient Access to Cancer and Autoimmune Treatments
Key Insights
The Alliance for Patient Access (search) warns that Medicare Part B drug price negotiations under the Inflation Reduction Act could unintentionally restrict access to vital medications for cancer and autoimmune disorder patients starting in 2028.
An Avalere (search) analysis projects at least $25 billion in lost provider add-on payments under the new maximum fair price model, potentially forcing small and rural practices to stop offering these medications or close entirely.
The transition to government-negotiated pricing introduces complex billing challenges and may force patients to travel farther for treatment, seek care in more expensive hospital settings, or go without essential therapies.
The Centers for Medicare & Medicaid Services (search)' upcoming drug price negotiation program for Medicare Part B medications could create significant barriers to patient access for life-saving treatments, according to a new issue brief commissioned by the Alliance for Patient Access (search). The program, set to take effect in 2028, will establish "maximum fair prices" for select Part B drugs, fundamentally changing how clinicians are reimbursed for these treatments.
Financial Impact on Healthcare Providers
The transition to government-negotiated pricing threatens the financial viability of healthcare practices, particularly smaller and rural providers. A recent Avalere (search) analysis projects a loss of at least $25 billion in provider add-on payments under the new maximum fair price model. These reduced margins may leave providers unable to cover drug acquisition and care delivery costs, potentially forcing difficult decisions about service offerings.
"Patients could face farther travel, increased prices, or go without essential treatments," said Josie Cooper, Alliance for Patient Access (search) Executive Director. "This threatens timely access to care and may reduce patient choice across the country."
Vulnerable Patient Populations at Risk
The policy changes pose particular risks for patients with cancer, autoimmune disorders, and other chronic illnesses who rely on Medicare Part B-covered medications. These patients may face several adverse outcomes as providers struggle with reduced reimbursement rates. Some healthcare practices may be forced to stop offering these medications entirely, while others might shift patients to more expensive hospital settings to maintain financial sustainability.
In the most severe cases, some practices may close their doors altogether, creating healthcare deserts in already underserved areas. This scenario would disproportionately impact rural and vulnerable populations who have limited healthcare options.
Implementation Challenges and Systemic Concerns
The transition to maximum fair price-based reimbursement introduces complex billing and data exchange challenges that further burden clinicians already struggling with administrative costs. These operational difficulties compound the financial pressures created by reduced reimbursement rates.
Independent pharmacies have already reported concerns about delays and financial instability under similar Part D changes implemented previously. These early warning signs suggest that the Part B negotiations could create widespread disruption for clinician-administered drugs across the healthcare system.
Call for Policy Refinements
The Alliance for Patient Access (search) is calling for greater transparency, stakeholder engagement, and flexibility from CMS as the program moves toward implementation. The organization emphasizes that without careful attention to these unintended consequences, patients may ultimately bear the cost of healthcare reform through reduced access to essential treatments.
The brief represents the first in a series from the Alliance for Patient Access (search) highlighting the importance of maintaining patient access as a central consideration in health policy reform conversations. While the goal of lowering drug prices enjoys broad support, the implementation details of the Inflation Reduction Act's Medicare negotiations require careful calibration to avoid undermining the very patients the policy aims to help.