Physicians could be facing a cut in reimbursement for drugs administered in their offices that cost more than $480, according to an Avalere analysis of the proposed Medicare Part B drug payment rule.

The Centers for Medicare & Medicaid Services recently proposed to test new pricing models aimed at lowering physician-administered drug costs. The proposal seeks to compare the traditional average sales price (ASP) plus 6% payment to a model of ASP plus 2.5% and an additional flat fee of $16.80.

Under the proposal, released in March, about half of physicians who administer Part B drugs would be paid under the traditional model, while the other half would be paid under the 2.5% plus $16.80 model. The evaluation, which would run for 5 years, is aimed at finding out if the new model will remove current incentives to prescribe higher-cost drugs.

CMS officials said they expect the lower add-on percentage combined with the flat fee “will cover the cost of any drug paid under Medicare Part B,” according to an agency fact sheet highlighting the proposed rule.

An Avalere analysis of the rule found that the impact varied by specialty.

Ophthalmologists could expect an 18% reduction in reimbursements, followed by oncologists at 14%, and rheumatologists at 6%. Hospital outpatient departments could see a 60% decrease in payments.

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