Intended for healthcare professionals


Evaluation of technologies approved for supplemental payments in the United States

BMJ 2019; 365 doi: (Published 17 June 2019) Cite this as: BMJ 2019;365:l2190
  1. Timothy J Judson, assistant professor of medicine1,
  2. Sanket S Dhruva, assistant professor of medicine12,
  3. Rita F Redberg, professor of medicine13
  1. 1Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
  2. 2San Francisco VA Medical Center, Section of Cardiology, San Francisco, CA 94121, USA
  3. 3Division of Cardiology, University of California, San Francisco, USA
  1. Correspondence to: R Redberg rita.redberg{at}

Supplemental payment programmes can increase access to new technologies, but Timothy Judson and colleagues find that some payments are made without clear evidence of safety and effectiveness

Approximately half of the rise in healthcare spending in the United States over the past several decades can be attributed to new technologies.1 Meanwhile, numerous technologies have been recalled or removed from the market because of serious safety concerns.23 Payers of healthcare must balance the potential benefit of access to new technologies with their added expense and often uncertain safety and effectiveness records.4 Many healthcare systems, including those of France, Germany, Japan, the United Kingdom, and the US, have payment mechanisms to support the use of new technologies.5 Although the specific requirements of each programme are slightly different, technologies approved for supplemental payments in the US often receive similar payments in other countries. Supplemental payments for new technologies are more common in France, Germany, and Japan than in the US,5 making this an important global issue.

In the US, the Centers for Medicare and Medicaid Services (CMS) offers new technology add-on payments (NTAPs) to mitigate financial losses for hospitals in the period before Medicare increases its diagnosis related group payments to reflect the added cost of a new technology.6 Device and drug manufacturers can apply for an NTAP immediately after approval by the Food and Drug Administration (FDA). Qualifying technologies must meet three criteria. They must be new, on the market for no more than three years; they must be costly, such that the existing Medicare rate provides inadequate reimbursement in the absence of an add-on payment; and they must offer a substantial clinical improvement for Medicare beneficiaries over existing technologies in the same diagnosis or treatment category.3

Since the programme’s inception in 2001, NTAP …

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