Congress Urged to Fix CMS Rule Distorting Part B Drug Reimbursement

LATE-BREAKING NEWS

Editor’s note: The ACR praises Congressional leaders for passing today’s (2/9) sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauded the inclusion of provisions that permanently repeal Medicare caps on outpatient therapies and other rehabilitation services, repeal the Independent Payment Advisory Board (IPAB) and eliminate the Medicare Part D donut hole.

When Congress signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law in April 2015, leaders of both parties celebrated a rare bipartisan achievement. But late last year, the CMS announced a rule through MACRA’s Merit-Based Incentive Payment pathway that would both consider Medicare Part B drugs costs when determining cost scores for reimbursement, as well as apply the MIPS penalties or bonuses to reimbursements for Part B drug costs. In 2019, providers will be subject to a 4% positive or negative adjustment calculated across several categories, including cost.

The ACR and many other physician groups believe the application of the adjustment is not in line with the goals of MACRA and could make it more difficult for physicians, particularly those in small practices and in rural settings, to administer Part B medications in their communities, thus creating another patient access issue.

The ACR’s Response
The ACR is a leader of a broad coalition of provider and patient groups, also led by the American Academy of Ophthalmology (AAO) and American Society of Clinical Oncology (ASCO), pushing Congress to reverse the CMS policy. If not fixed, rheumatologists and other specialist providers could be penalized for providing Part B drugs beginning in 2019. But legislators have been reluctant to open it back up, says ACR Government Affairs Committee Chair Angus Worthing, MD, FACR, FACP.

“CMS finalized its decision to move this new policy forward in November 2017 despite strong congressional opposition,” Dr. Worthing says. “This means it will take an act of Congress to fix the problem and change CMS policy.

“That’s exactly what we’re aiming for,” he adds.

Although rheumatology is a small specialty, the ACR has taken robust leadership on this issue. For example, on Jan. 18, the ACR co-authored a letter to relevant House and Senate committee members to urge a fix.¹ The ACR helped garner more than 100 organizational co-signers across the country, including the American Academy of Dermatology, American Academy of Neurology, American College of Gastroenterology, National Psoriasis Foundation, Arthritis Foundation and many others, including state and local rheumatology societies.