Alliance Commends Site Neutral Provisions in Senate Drug Pricing Package

Site neutral policies in the Prescription Drug Pricing Reduction Act (PDPRA) of 2019 approved by
the Senate Finance Committee will lower out-of-pocket costs for seniors.

Washington, DC, July 26, 2019 --(PR.com)-- The Alliance for Site Neutral Payment Reform (Alliance)
today applauded the Senate Finance Committee for incorporating two site neutral policies in the
Prescription Drug Pricing Reduction Act (PDPRA) of 2019. If enacted into law, these provisions will
increase transparency and lower out-of-pocket prescription drug costs for seniors.

Costs for physician administration of covered Medicare vaccines and other drugs vary dramatically
according to the site of service. Currently, hospital outpatient departments (HOPDs) that are exempt from
site neutral policies under the Bipartisan Budget Act of 2015 and the 21st Century Cures Act of 2015 are
reimbursed at significantly higher rates than independent physician practices for providing the exact same
services. For the administration of chemotherapy drugs, for example, the payment to a hospital outpatient
facility is more than double the rate paid to a community cancer clinic ($288 vs $143). As a result,
patients are paying higher out-of-pocket costs and employers, Medicare, and taxpayers are saddled with
increasing costs to the health care system.

Section 111 of PDPRA would remove the exception for “grandfathered” off-campus HOPDs, and
payment for the professional service of administering a Medicare Part B drug would be made at the
physician office rate rather than the HOPD rate beginning January 1, 2021. Because Medicare beneficiary
cost-sharing is directly related to the Medicare payment rate for the drug and the administration of the
drug, this provision will have an immediate impact on out-of-pocket costs for seniors.

Under Section 106, the transparency tool created by the 21st Century Cures Act of 2015 would be
modified to include information for services furnished in a physician office. This will help patients better
understand the variations in cost by site of care and the impact on their out-of-pocket costs.

The Alliance commended the Senate Finance Committee for recognizing that the skyrocketing cost of
healthcare is not sustainable for patients and taxpayers alike. Advancing the policies outlined above will
help lower out-of-pocket costs, enable patients to make more informed healthcare decisions, provide
stability to the Medicare program, and end payment disparities that have led to consolidation across the
healthcare marketplace.

About the Alliance for Site Neutral Payment Reform

The Alliance for Site Neutral Payment Reform is a coalition of patient advocates, providers, payers and
employers who support payment parity across site of service in order to decrease Medicare and
commercial spending, ensure patients receive the right care in the right setting, lower taxpayer and
beneficiary costs and increase patient access. Our growing membership represents healthcare providers,
patient and consumer groups, insurers and others who believe patients - and the healthcare system -
would be better served by policies that are fiscally wise and preserve and enhance care options. Visit
siteneutral.org to learn more.

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Contact Information:
Alliance For Site Neutral Payment Reform
Ellen Almond
703-548-0019
Contact via Email
http://www.siteneutral.org/

Online Version of Press Release:

You can read the online version of this press release at: https://www.pr.com/press-release/790804

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