Most favored nation drug pricing- end of oncology PP?

[MD2018_DM]

So if this gets implemented (after lawsuits and back and forth from the time the Executive Order is signed), should we expect a lot of small cancer centers/PP to shut down? This looks like a dramatic reduction in infusion reimbursement for not an insignificant number of patients.

Not trying to fear monger, just truly asking to plan ahead. Obviously this is a complex issue, but it all seems to come to affecting providers/cancer centers the most right?

---

Members don't see this ad.

 

[HemeOncHopeful19]

Interestingly he tried to do this during his last administration and it looks like the Biden admin walked it back - although the Inflation Reduction Act also did not do us any favors.

But yes if this sort of thing passes I would expect all of us to end up employed by 340B departments within a decade.

 

[chessknt]

Primary care, nephro, rheum, endo, pulm all still manage to have private practices without infusion centers--if you want to stay independent it is possible just expect you're going to have to grind much harder for it like all the other plebs who don't have access to a cash tsunami.

 

[HemeOncHopeful19]

Primary care, nephro, rheum, endo, pulm all still manage to have private practices without infusion centers--if you want to stay independent it is possible just expect you're going to have to grind much harder for it like all the other plebs who don't have access to a cash tsunami.

We’re grinding pretty hard thanks

If there’s a tsunami of cash in ASP+6% in the era of white baggings and PBMs, then I must’ve been born with water wingies

 

[ONC2023]

When I was on the interview trail, I was told by some private groups that their financial backup plan if they ever got into trouble was to enter into a physician service agreement with the local hospital. They said that this would cause them to lose some autonomy but that their revenues/profits would increase because of access to 340b pricing.

I guess it’s not full private practice, but it seems like the best of both worlds?

 

[HemeOncHopeful19]

When I was on the interview trail, I was told by some private groups that their financial backup plan if they ever got into trouble was to enter into a physician service agreement with the local hospital. They said that this would cause them to lose some autonomy but that their revenues/profits would increase because of access to 340b pricing.

I guess it’s not full private practice, but it seems like the best of both worlds?

Not a great backup plan imo - local hospital would rather just employ you and what are you gonna do about it?

 

[gutonc]

Not a great backup plan imo - local hospital would rather just employ you and what are you gonna do about it?

Yeah, I agree. I suspect it's a situation where the hospital would do a PSA for a few years and then offer a "take it or leave it" buyout offer where the senior partners will make out pretty well and the junior and non-partners will get hosed.

 

[chessknt]

We’re grinding pretty hard thanks

If there’s a tsunami of cash in ASP+6% in the era of white baggings and PBMs, then I must’ve been born with water wingies

You are earning 2x per unit vs the non procedural specialties, probably the highest per unit reimbursement in all of IM that have no opportunity to make margins on six figure prescriptions. No idea how that is possible if there isnt a huge cash float behind that. Not sure if you ever worked outside of the specialty but your reference might be off here but the specialty will survive just the same as the other IM subspec have.

 

[MD46]

You are earning 2x per unit vs the non procedural specialties, probably the highest per unit reimbursement in all of IM that have no opportunity to make margins on six figure prescriptions. No idea how that is possible if there isnt a huge cash float behind that. Not sure if you ever worked outside of the specialty but your reference might be off here but the specialty will survive just the same as the other IM subspec have.

Would you say compared to a cardiothoracic surgeon a pulmonologist is paid fairly? the person I refer my patients to makes close to 3 mil every year? he is quite busy but even if a pulmonary doc was that busy wouldnt come to close to even a mil.

 

[Plutarch02]

I seriously doubt this takes hold, an executive order doesn't have the legal weight to accomplish this. Pharmaceutical company stocks didn't go down much yesterday so I feel Wallstreet agrees.

 

[HemeOncHopeful19]

You are earning 2x per unit vs the non procedural specialties, probably the highest per unit reimbursement in all of IM that have no opportunity to make margins on six figure prescriptions. No idea how that is possible if there isnt a huge cash float behind that. Not sure if you ever worked outside of the specialty but your reference might be off here but the specialty will survive just the same as the other IM subspec have.

Those double RVU employed jobs are typically at 340B institutions as alluded to in this thread.

 

[Ubba]

You are earning 2x per unit vs the non procedural specialties, probably the highest per unit reimbursement in all of IM that have no opportunity to make margins on six figure prescriptions. No idea how that is possible if there isnt a huge cash float behind that. Not sure if you ever worked outside of the specialty but your reference might be off here but the specialty will survive just the same as the other IM subspec have.

If reimbursement does come down substantially due to these changes without offsetting increase in $/RVU, expect a precipitous drop in Heme/Onc fellowship applicants from the American residency-trained pool. Grads are getting smarter. They know about opportunity cost now. 3 years of fellowship to sling highly toxic drugs with all the attendant liability (sorry, but that's the best science has to offer right now) just to make general IM money is financially absurd. I'd never have done it.

But sure. Will "grind" and set a hard 12-minute visit cutoff if it comes down to that.

 

[sloh]

@bronx43

 

[chessknt]

If reimbursement does come down substantially due to these changes without offsetting increase in $/RVU, expect a precipitous drop in Heme/Onc fellowship applicants from the American residency-trained pool. Grads are getting smarter. They know about opportunity cost now. 3 years of fellowship to sling highly toxic drugs with all the attendant liability (sorry, but that's the best science has to offer right now) just to make general IM money is financially absurd. I'd never have done it.

But sure. Will "grind" and set a hard 12-minute visit cutoff if it comes down to that.

Yep that is what the system wants. Nephrology died because of medicare and dialysis corporate ownership yet all those people are still getting care. Time to join the club--no special bonus for dealing toxic meds, you get the same E/M codes everyone else gets because the system is bull**** that doesnt account for complexity or risk outside of a three tier system. Maybe with you guys behind the rest of us we can burn the ****er down faster.

 

[Plutarch02]

I doubt drug companies are going to voluntarily lower their prices and when this was tried in 2020 is was struck down by courts. Also administering chemo is associated with professional billing codes 96401-96549. Yes the drug prices going down would hurt, but it wouldn't completely negate the revenue oncologists take in. Also a lot of chemo drugs, platinums, doxorubicin, gemcitabine etc are generic and are already lower priced than overseas.

 

[MD46]

Yep that is what the system wants. Nephrology died because of medicare and dialysis corporate ownership yet all those people are still getting care. Time to join the club--no special bonus for dealing toxic meds, you get the same E/M codes everyone else gets because the system is bull**** that doesnt account for complexity or risk outside of a three tier system. Maybe with you guys behind the rest of us we can burn the ****er down faster.

Dont live in a fools paradise, what you suggest, I dont see that happening in the next 10-15 years at least. Pharma pockets are quite deep, trump likes money and so on.....

 

[Plutarch02]

For what it's worth here's an article interviewing CFO from Mckesson, their stock is currently continuing to go up. They're not anticipating much if anything to come from MFN.

McKesson at Bank of America Conference: Strategic Growth and Separation By Investing.com

McKesson at Bank of America Conference: Strategic Growth and Separation

www.investing.com