The ACR has long supported allowing Medicare to negotiate with pharmaceutical companies to make treatments more affordable. To achieve this shared goal without harming Part B providers, we are asking for the Senate’s attention regarding the unintended consequences of some policies related to drug pricing in the House-passed version of the Build Back Better Act.
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Explore This IssueJanuary 2022
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The ACR is supportive of several healthcare provisions included in the version of the Build Back Better Act passed by the House of Representatives. These policies support the rheumatology community and would help patients across the country secure access to quality care. We particularly support the current provisions that will:
- Fund 5,000 additional Medicare graduate medical education (GME) training slots;
- Require pharmacy benefit managers to report compensation, costs, fees and rebates every six months to group health plan sponsors;
- Negotiate a maximum fair price for select treatments under Medicare;
- Mandate rebates for prescription drug cost inflation that exceeds certain benchmarks;
- Cap out-of-pockets costs to Medicare patients at $2,000 annually;
- Cap monthly cost-sharing payments for Medicare users of certain prescription drug plans;
- Provide $500 million to support qualifying medical schools; and
- Expand funding for public health systems and GME.
Regarding the drug pricing provisions, the ACR has long held the position that Medicare should be able to negotiate with pharmaceutical companies and that patients’ out-of-pocket costs should be capped to make drugs more affordable. However, we are concerned about the potential unintended consequences of certain drug pricing provisions that put physicians and their patients in the middle of the proposed “negotiation” between the government and drug manufacturers.
Specifically, as passed by the House, the bill risks unsustainable cuts to Medicare reimbursements to providers who administer drugs covered by Medicare Part B. Providers must prepay manufacturers to acquire the drugs before they are administered so they can provide timely care to patients with serious diseases. Although the maximum fair price would be set by Congress, concessions after the point of sale could result in providers being reimbursed less than the amount they paid to acquire the drug initially. We are urging the Senate to modify these provisions to ensure reimbursement to physicians who have already purchased these expensive treatments is at a level that allows Part B providers to continue to treat their patients in a practice setting—a win for patients, access and Medicare.
Like past policies that decreased Medicare Part B reimbursements without considering the way in which physicians must acquire the drugs, the new bill risks the consolidation or closure of independent practices and may force patients to seek care in more expensive settings. This threatens access to care and may result in many patients paying more for drugs and medical care—the opposite of what the Build Back Better Act intends. This is a particularly high risk for elderly Medicare recipients living in rural areas, who already face significant barriers to care. The goals of the Build Back Better Act, though admirable, are not served by the current wording that may force patients to travel farther for care or seek care in more expensive settings.