CMS Faces Major Challenges As It Establishes Itself As A Health Technology Assessment Entity In The Wake Of The IRA

The Centers for Medicare and Medicaid Services (CMS) have been incrementally shouldering increased health technology assessment (HTA) responsibilities, particularly in light of the Inflation Reduction Act's provisions pertaining to drug pricing. However, this expanded role may be better managed with the establishment of a dedicated HTA entity singularly devoted to technology evaluation. It is noteworthy that CMS has possessed the authority for some time to withhold national reimbursement for services that do not meet the criterion of being "reasonable and necessary" for diagnosis and treatment. The evolving landscape of healthcare technology underscores the growing importance of comprehensive HTA processes. While CMS has incorporated HTA elements into its operations, an independent HTA entity could offer more specialized focus and expertise, potentially enhancing the efficiency and effectiveness of technology evaluations. Furthermore, the ability to withhold reimbursement for services deemed not meeting the "reasonable and necessary" standard underscores the significant role CMS plays in healthcare policy and the regulation of emerging technologies within the Medicare and Medicaid frameworks.