Breakthrough Products Coverage Bill Introduced

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Sen. Dan Coats (R-IN) has introduced S. 2998, the Ensuring Patient Access to Critical Breakthrough Products Act, to “establish a program to accelerate transitional coverage and payment for new technologies that offer breakthroughs for serious illnesses affecting Medicare beneficiaries.” In a statement, the senator says that “researchers and entrepreneurs … regularly come up with groundbreaking new treatments for some of our worst illnesses, only to encounter government regulations that prevent many patients from receiving potentially life-saving care. This legislation would streamline the current process, allowing Medicare patients to receive new treatment while also ensuring proper safety and quality regulations are met.”

He says that currently, once a new technology passes the FDA expedited review program, it may take up to three years to navigate the HHS Centers for Medicare and Medicaid Services (CMS) coverage and reimbursement process. Thus, he says, years could pass before Medicare beneficiaries are able to access the approved medical breakthroughs.

Under the bill, new treatments approved by FDA would be given a three-year temporary coverage period during which they would receive a guaranteed level of payment. CMS could specify what additional data would be needed to continue coverage after the three-year period under its statutory “reasonable and necessary” standard.

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