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Cures Bill Would Boost Companies' Chances for Medicare Coverage

By Kerry Young, CQ Roll Call

December 1, 2016 -- The so-called Cures bill would offer makers of drugs and medical devices and health professionals two different forms of new assistance in their bids to secure Medicare payments for products and treatments.

The bill (HR 34), which the Senate is expected to clear next week, calls for the creation of a kind of internal referee, or ombudsman, to work with makers of drugs and devices. The measure also would increase public knowledge about how the Medicare program handles regional differences in its coverage policies. The House passed the measure 392–26 on Wednesday.

Winning Medicare coverage for products and treatments can be crucial, as the giant federal health program pays for or influences much of American health care. Medicare spending is more than $600 billion a year and dominates several medical fields, including cancer treatments and cardiology.

Medicare has two different tracks for deciding whether to cover certain treatments. Officials can open a national coverage decision, or allow the program's contractors to make local coverage decisions. The Cures bill would require Medicare's administrative contractors to post online a summary of the evidence used in making a local coverage decision, and an explanation of the reasons for its decision.

Now local coverage decisions "are essentially made in a black box, so the provision will help ensure accountability as these decisions are made, while helping other jurisdictions learn what and why coverage determinations are made," Joel White, president of Horizon Government Affairs and a former House Ways and Means staffer, told CQ HealthBeat. "This will help improve coverage across the program. Medicare is a national program. Beneficiaries shouldn't face inconsistencies due to accidents of geography."

The bill also would require the Centers for Medicare and Medicaid Services to set up a pharmaceutical and technology ombudsman. This official would respond to complaints from companies that have had setbacks in their efforts to obtain Medicare coverage for their products.

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