ACR Expresses Concerns with MedPAC's Drug Pricing Recommendations

In April, the Medicare Payment Advisory Committee (MedPAC) voted to recommend a change in the add-on payment for Part B drugs in their next report to Congress.

Currently, the add-on payment is the average sales price of the drug plus 6%. The new policy recommendations would alter payment to maintain the 6% add-on payment for low-cost drugs, reduce the add-on payment for mid- to higher-cost drugs, and place a cap on the add-on payment for the costliest drugs.

The ACR sent a letter to MedPAC expressing concerns with these recommendations and highlighting the significant impacts these policies would have on rheumatologists. Of note, MedPAC recommendations are not binding; however, they do indicate future discussions on add-on payments.

The Medicare Payment Advisory Commission (MedPAC) makes recommendations to Congress on Medicare policy including physician payments and patient access issues. These recommendations can directly impact rheumatology care coverage and rheumatologist reimbursement. Representatives of the ACR and partners recently met with new MedPAC Executive Director James E. Mathews, PhD, to discuss appropriate recognition of rheumatology care…

MedPAC recommends deep cuts to physician payments

The Medicare Payment Advisory Commission (MedPAC) reported to Congress in January that Medicare’s switch to a payment method known as ASP, or Average Sale Price, has reduced spending on drugs in the Medicare Part B program. This system reflects actual market spending, rather than wholesale prices.

In a letter to Congress, the ACR, AMA and other groups urge legislation that would provide annual inflation-based Medicare payment updates based on the full Medicare Economic Index.

ACR Expresses Concerns with MedPAC’s Drug Pricing Recommendations

At the Table: ACR Meets with MedPAC

Rheumatologists React to Looming Medicare Payment Reductions

Medicare Switch to ASP Pricing Reduces Part B Spending

The ACR Recommends Inflation-Based Medicare Payment Updates

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