On June 15, the ACR and partnering physician specialist groups passed an American Medical Association (AMA) resolution opposing the proposed Medicare Part B drug payment demonstration during the AMA House of Delegates (HOD) meeting held June 11–15 in Chicago.
Part B Payment Demo Resolution
The resolution, which the ACR supported with the American Society of Clinical Oncology (ASCO) and other specialty groups, means the AMA will support and actively work to advance Congressional action to block the Medicare Part B payment demonstration project by CMS. A second resolution sponsored by the ACR, ASCO and the American Academy of Ophthalmology (AAO) would exempt Medicare Part B and D drug costs from resource use assessments under MACRA. If these were included without appropriate modification/risk stratification, it would create an SGR-like effect for specialties utilizing high-cost drugs, such as biologics, for our patients.
A resolution similar to that passed by the House of Delegates was authored by the ACR and introduced with 10 co-sponsoring national specialty provider groups, including the ACR, ASCO, AAO, American Academy of Allergy, Asthma & Immunology, American Association of Clinical Urologists, American College of Allergy, Asthma and Immunology, American College of Gastroenterology, American Gastroenterological Association, and the American Society of Cataract and Refractive Surgery. It outlined specialty providers’ concerns regarding the proposed Part B payment demonstration, including the fact that some specialties—such as rheumatology and gastroenterology—have very few Part B biologics available to patients, and that these therapies do not have less expensive alternatives. Each patient’s immunology is unique, and due to their complexity, biologics and chemotherapy drugs cannot be easily interchanged.
Other specialties, such as ophthalmology, must have Part B drugs and biologics compounded or repackaged before they can be used to treat certain conditions. Due to new federal and state drug compounding regulations, some physicians are experiencing increased difficulty accessing compounded or repackaged drugs and biologics.
In the event the Part B proposal is not withdrawn by CMS, the ACR resolution also called for significant modifications to the proposal, including:
- Evaluating the changes to the Part B program in a much smaller demonstration project that examines the impact on patients, including the availability of high-quality and affordable services, availability of equivalent alternative therapeutic products with price differentials, average total per-patient Medicare costs by drug and average per-beneficiary cost, and phasing-in of changes to allow adjustment of operations to ensure that beneficiaries’ access to care is not disrupted;
- Considering MACRA timeframes and changes and the impact of these changes; and
- Establishing key exemptions to protect the most vulnerable Medicare-covered patients and providers.
Should CMS fail to respond to stakeholder input and withdraw or significantly modify the Part B drug payment demonstration project and CMS proceeds with the proposal, the resolution directs the AMA to support and actively work to advance Congressional action to block the demonstration. It also directs the AMA to advocate against policies that are likely to undermine access to the best course of treatment for individual patients and to oppose demonstration programs that could lead to lower quality of care and do not contain mechanisms for safeguarding patients. It further directs the AMA to advocate for ensuring that CMS solicits and takes into consideration feedback from patients, physicians, advocates or other stakeholders in a way that allows for meaningful input on any Medicare coverage or reimbursement policy that affects patient access to medical therapies, including policies on coverage and reimbursement.