Action Needed to Protect Patients with Complex Medical Conditions

Over 335 patient, provider, and caregiver groups are deeply concerned with the unprecedented, experiment — called the Medicare IPI Model — affecting Medicare beneficiaries who take Part B-covered drugs. With IPI, Medicare has proposed layering on a new middleman between physicians and patients. Taking the form of vendors that would impose requirements dictating treatment for patients with cancer, autoimmune disorders and other complex, life-threatening conditions, IPI stands between patients and personalized care their physicians prescribe.

In a letter to Congress they wrote this about IPI:

The proposed model would put vendors with no clinical or medical expertise between patients and doctors. Vendors would inevitably impose restrictions on beneficiary access to drugs through formularies, disrupting or delaying care in the pursuit of profit. Medicare Part B beneficiaries have a right to access the Part B-covered drug prescribed by their physician based on his or her medical knowledge and experience. Beneficiaries would effectively lose this right under the model, as vendors that beneficiaries did not choose will dictate the types of drugs they can use. This is particularly risky for vulnerable Medicare patients with cancer and autoimmune or ophthalmic conditions who require complex treatment regimens. Medicare Part B beneficiaries face debilitating consequences if they cannot access the Medicare Part B drugs prescribed by their physician, or if their physician cannot modify their treatment quickly as circumstances change. While this model will likely be positive for the bottom lines of vendors such as PBMs, it will be a net negative for patients and providers, and create new inefficiencies and burdens in the delivery system.

You can let Congress know that you share these concerns by joining efforts with Patients + Providers United.