Medicare Part B Drug Payment Model

What Does the Medicare Part B Drug Payment Model Mean for Hospitals, Physicians and Biopharmaceutical Companies?

The Department of Health and Human Services (HHS) has proposed a major, national payment model that would, if implemented, significantly impact how Medicare pays for drugs provided through the Part B program. Under the authority of the Center for Medicare and Medicaid Innovation (CMMI), HHS is proposing a new payment formula in about half of the states as early as August 1. Changing the incentives for prescribing certain drugs, the new formula would strongly affect reimbursement and revenues for a wide range of providers.

HHS also is proposing a second phase of the model that would introduce "value-based drug pricing." This approach could further impact prescribing incentives, as well as hospital and physician revenues.

What's in the new proposal? How will it change the landscape for drug reimbursement, especially for high-cost medicines? And, critically, will the plan be implemented—and when? Learn what the proposal means to you at a free Manatt Health webinar. During the program, you will:

  • Learn the motivations behind this proposal.
  • Understand the legal basis for the proposal and how that will impact whether and how it is implemented.
  • Explore what the proposal's changes could mean.
  • Discover how the proposal could impact different providers and drug types.
  • Find out how various constituencies are reacting to the proposal.
  • Hear projections on what may happen to the plan in this highly political year.

If you would like to receive an audio transcript of this webinar due to accessibility issues, please email us at

This program does not constitute legal advice, nor does it establish an attorney-client relationship. Views expressed by presenters are strictly their own and should not be construed to be the views of Manatt or attributed to Manatt.



pursuant to New York DR 2-101(f)

© 2023 Manatt, Phelps & Phillips, LLP.

All rights reserved