Health care providers are expressing concern about two new programs recently announced by the Department of Health and Human Services: the Centers for Medicare & Medicaid Services’ Medicare WISeR (Wasteful and Inappropriate Service Reduction) Model and HHS’s 340B Rebate Model Pilot Program.
The WISeR model, to be tested in six states, will require doctors to obtain prior authorization before providing a limited group of services. That prior authorization is expected to be delivered primarily through the use of AI. Participation will be mandatory in the states involved in the program and providers are concerned that it will increase their administrative burden and delay care; they also fear it could lead to greater use of prior authorization in the traditional Medicare program in the future. CMS’s Center for Medicare and Medicaid Innovation characterizes the services in question as being of “low value” and potentially wasteful and maintains that its new approach could lead to cost savings – one of the major objectives of CMMI models.
The 340B Rebate Model Pilot Program is a new, voluntary program that will enable drug manufacturers to provide post-sale rebates to 340B-covered entities instead of upfront discounts on those products. While regulators and pharmaceutical companies believe this approach – voluntary for the drug companies at first – will be fairer and more transparent, providers that participate in the program question its legality, fear it will drive up their costs, and are concerned that it may undermine the original intent of the program.
Learn more about concerns surrounding these two new programs from the Healthcare Dive article “Medicare prior authorization pilot raises concerns among providers” and the Becker’s Hospital Review report “Pressure mounts against HHS’ 340B pilot: 5 notes.”