A recent Politico article outlined the looming agenda facing Congress as 2018 begins: Fund the government, raise the debt ceiling, modify spending caps, address healthcare subsidies, allocate additional funds for disaster relief, and address the status of millions of undocumented young immigrants.1
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Amid all that activity, the ACR, through its Government Affairs Committee (GAC) and the advocacy work of ACR/ARHP members, continues to advocate for rheumatology professionals and patients.
The ACR’s Priorities
For 2018, the ACR has a long list of legislative and regulatory priorities to address at both the federal and state levels.
MIPS Adjustment/Part B Cost Elimination
Most immediately, says Angus Worthing, MD, FACR, FACP, GAC chair, we need to promote legislation that eliminates MIPS adjustments for Part B drug costs in MACRA, while pressuring the Centers for Medicare and Medicaid Services (CMS) to eliminate Medicare Part B costs or include Part D when calculating physician quality scores under the Merit-Based Incentive Payment System (MIPS) that was set up through MACRA along with an alternative payment model (APM) pathway for Medicare payment.
Under a rule finalized by the CMS in late 2017, items and services—including Part B drugs—furnished by providers on MACRA’s MIPS pathway (which applies to nearly all rheumatologists) would be subject to either a positive or negative adjustment. This is a significant departure from previous policy, which only applied penalties or bonuses associated with quality programs to payment for physician services, not to payments for items such as Part B drugs for which physicians are reimbursed. Estimates project a financial impact in the range of 16–19% for some specialties.2
The ACR also continues to work toward the development of a MACRA alternative payment model (APM) appropriate for rheumatologists.
Drug Prices, Access & PBM Transparency
Drug prices and access to drugs also continue to be a focus of the ACR’s legislative and regulatory efforts, says Dr. Worthing. These are “probably top of the radar screen for most Americans, many members of Congress and the ACR,” he says. “It’s a multifaceted problem that is very frustrating for us in this day and age when we have the tools to diagnose and treat severe disease, and it can be heartbreaking when patients can’t access medications they’re prescribed.”
Promoting greater awareness of the role pharmacy benefit managers (PBMs) play in what patients must pay for drugs, and increased transparency of PBM practices, are among the ACR’s priority efforts in 2018 intended to address cost and access.