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May 15, 2019

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Urge CMS to Improve Antibiotic Reimbursement and Stewardship

The announcement of the bankruptcy of Achaogen, the small company that developed plazomicin, underscores the urgent need for the federal government to protect and strengthen the antibiotic pipeline. At IDSA’s insistence, the Centers for Medicare and Medicaid Services has issued a new proposal with the aim of improving antibiotic reimbursement. Unfortunately, the proposal is insufficient to impact the antibiotic pipeline and neglects stewardship.  We need your help—tell CMS to improve antibiotic reimbursement and require stewardship and antibiotic use and resistance data collection.

CMS is proposing to increase New Technology Add On Payments (NTAP) for certain new antibiotics and to allow for a slightly increased Medicare bundled payment (Diagnosis Related Group or DRG) for patients with infections caused by resistant pathogens. Unfortunately, these new payments would not reach hospital pharmacy budgets and therefore are unlikely to impact access and utilization. Further, the size of the payments is too small to allow innovators to earn a fair and reasonable return on their investments.  Finally, the CMS proposal does not include stewardship.

IDSA is urging CMS to carve out new antibiotics from the standard Medicare bundled payment to pay for new antibiotics separately, while also requiring hospitals to implement robust stewardship programs and to report antibiotic use and resistance data to CDC. This more comprehensive approach will:

  • help ensure clinicians can prescribe new antibiotics when clinically appropriate;
  • provide companies that launch new antibiotics an opportunity to earn a fair and reasonable return on their investment, which is essential to sustain the antibiotic pipeline;
  • promote implementation of ID physician-led stewardship programs; and
  • strengthen the availability of important data on antibiotic use and resistance patterns.

Let CMS know that these priorities matter to you, your patients, and your community by clicking Take Action below and submitting feedback on the rule, which is open for public comments until June 24.

Take Action

IDSA also recognizes that reimbursement reform alone is likely insufficient to secure the robust and renewable antibiotic pipeline necessary to meet current and future patient needs.  We continue to work with stakeholders to develop and advance a consensus proposal for a market entry reward, and have recently communicated the urgent need for federal action to the Food and Drug Administration and the HHS Assistant Secretary for Preparedness and Response.

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