Greetings, advocates! Here’s a brief, interim hodgepodge of updates to keep you posted on government advocacy before the deluge of information swamps you in San Diego.
The Next Big Thing: Part B Drug Reimbursements
Medicare currently plans to adjust reimbursement of doctors in the MIPS program in 2019, not only based on E/M office services, but also on items provided to patients—including Part B drugs. The math just doesn’t work on this: getting the average sales price (ASP) + 6% reimbursement on thousands of dollars for pass-through drug costs, then being at risk for a 4% reduction of that whole drug cost. Then in 2022, there’s a risk of a 9% cut, setting up an absurd situation in which doctors would effectively be paying 3% of patients’ infusion bills back to Medicare. Congressional staff members were aware of this problem when the ACR Executive Committee visited them on the Hill in September, but they are waiting to see what the CMS does. It appears that Medicare will publish its final ruling on this by Nov. 1.
To find out the thrilling next chapter in this story, saunter over to the advocacy sessions at the ACR/ARHP Annual Meeting on Sunday at 8:30 a.m. and Sunday at 1 p.m. (A member of Congress is scheduled to speak at this legislative and regulatory update session.) Meanwhile, your advocacy team has met with Congress, written letters through large coalitions and staged a large grassroots email campaign to get Congress to pressure Medicare to fix this. Stay tuned!
Biosimilars
With five FDA-approved rheumatology biosimilars in the U.S., now is the time to learn about this topic, and stay informed as the landscape changes. In San Diego, check out the Great Debate and other biosimilars sessions with Jonathan Kay, MD, a rheumatologist in Worcester, Mass., affiliated with UMass Memorial Medical Center, and Gene Huffstutter, MD, a practicing rheumatologist in Hixson, Tenn.
Also stay tuned for the ACR’s upcoming biosimilars white paper. Meanwhile, the U.S. marketplace is still waiting for the FDA to finalize the approval pathway for interchangeable biosimilars (Note: These are the ones that could be substituted at the pharmacy for the bio-originator you prescribe). The ACR’s wish list for the FDA and CMS includes meaningful suffixes, individual billing codes for reimbursement and labeling changes (e.g., to clearly state if a drug is a biosimilar and whether it is interchangeable; the addition of clinical data or a hyperlink to the data package).
Trump’s Executive Order & Cost-Sharing Reduction
Last week, the president issued an executive order that reduced insurance restrictions in order to expand the abilities of business associations to sell insurance; he also announced that he would stop making cost-sharing reduction payments to insurers. Your advocacy team announced in an emailed statement that the ACR will be working to address both these actions on your behalf.
First, and more urgently, as Congress and the administration negotiate the terms regarding whether and how to fund the cost-sharing reduction payments, the ACR will continue to suggest that lawmakers in Congress continue to keep patient protections strong as per ACR policies. (Want to help keep these protections strong? Help the ACR strengthen its relationships on the Hill by investing in RheumPAC.)
Second, as the executive order on insurance takes form over the next year through the federal agency rulemaking process, the ACR will provide comments to the government on how best to protect our profession and patients.
One Last Thing: Sign up for the Advocacy Email Group
Click here to join the new ACR Advocacy discussion group powered by Google Groups. Post your thoughts by emailing [email protected].
Hope to see you in San Diego at the advocacy booth in the ACR Discover Center.
Angus Worthing, MD, FACP, FACR, chair, Government Affairs Committee, is a practicing rheumatologist in the Washington, D.C., metro area and clinical assistant professor of medicine at Georgetown University.
