For the first time, Medicare’s Drug Price Negotiation Program will focus on Part B therapies. Unlike pharmacy drugs covered by Medicare Part D, Part B therapies typically involve complex procedures, like injections and infusions, and are administered by professionals in health care settings. Conditions that are commonly treated that way include arthritis, asthma, autoimmune disorders, cancers and migraine. The “maximum fair price” negotiated by Medicare for the first set of Part B treatments will be implemented in 2028.
Pressure on Independent Practices
Part B medicines are typically administered in an office or clinic setting. Clinicians procure, store and administer complex medicines to ensure the integrity of the medicine and the safety of their patient. Clinicians are typically paid an administration fee to reflect these extra costs.
If price changes are implemented imprudently, they will create financial hardships for independent medical practices who deliver these therapies. If community practice clinics cannot afford to continue offering Part B treatments at the negotiated rate, patients could be referred to larger systems, which may create geographic complications and often have a higher cost, or be forced to change their medications.
Independent and community-based clinicians are watching nervously as Medicare establishes the MFP’s that will ultimately impact the reimbursement payments that pay their bills. One proposed reform, the Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299), aims to ensure CMS and patients benefit from lower prices without clinicians and care sites being squeezed by lower reimbursement. Independent and community medical practices are already struggling to survive in an era of rapid corporate consolidation.
Reforming Costs Without Reducing Care
Medicare has already completed two rounds of price negotiations for 25 drugs covered under Part D, with the first 10 prices already haven taken effect. In each case, Medicare seeks to control its own spending on these treatments, especially for medicines where the expected patient population is likely to rise. Expenditures on the six identified Part B treatments being negotiated this year totaled $9.27 billion from November 2024-October 2025, according to CMS estimates.
For Part B drugs, reimbursement rates should reflect the specialized training and clinical oversight required to store and administer these medications safely and effectively. Especially in smaller settings that struggle with staffing and costs, a negotiated rate that negatively impacts clinician reimbursement could result in fewer patients having access to care. Patients with challenging conditions treated by Part B therapies may find it difficult to travel to distant medical centers that benefit from these lower rates.
As Medicare drug pricing policy evolves, implementation details will matter. Policymakers should focus on reforms that lower cost while protecting patient access and timely, local care.