The ACR’s 2018 Legislative & Regulatory Priorities

Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.

References

1. Alberta, T, Bade R. Paul Ryan sees his wild Washington journey coming to an end. Politico Magazine. 2017 Dec 18. https://www.politico.com/magazine/story/2017/12/14/paul-ryan-retire-speaker-ready-leave-washington-216103.
2. American Society of Clinical Oncology, American College of Rheumatology. Submission to the AMA House of Delegates on opposing inclusion of Medicare Part B drugs in QPP/MIPS payment adjustment [resolution]. 2017 Oct 12. https://www.ama-assn.org/sites/default/files/media-browser/public/hod/i17-225.pdf.

Sidebar: Top ACR Policy Priorities for 2018
Here’s a quick rundown of some of the ACR’s major priorities this year.

Federal Legislative

• Ensure appropriate implementation of MACRA, including regulatory reform, optimizing MIPS for rheumatology care, avoiding MIPS adjustments of Part B drug reimbursements, including Part D drug costs in cost measures or eliminating Part B drug costs from resource use, and supporting a rheumatology-related APM.
• Ensure any healthcare reform efforts prioritize affordable, meaningful health insurance coverage for chronically ill patients.
• Support interventions to address adult and pediatric rheumatology workforce shortages.
• Support increased funding for research by the NIH, CDC and DOD in rheumatic disease and related comorbidities.
• Promote greater awareness of pharmacy benefit managers’ (PBMs) role in drug pricing. Promote transparency of PBM practices.
• Repeal the arbitrary cap on Medicare outpatient rehabilitation services.

Federal Regulatory

• Ensure appropriate implementation of MACRA, including regulatory relief and deceasing administrative burden, optimizing MIPS for rheumatology care, avoiding MIPS adjustments of Part B drug reimbursements, including Part D drug costs in cost measures or eliminating Part B drug costs from resource use, and supporting a rheumatology-related APM.
• Increase awareness of and payment for cognitive specialists’ time, expertise and services; advance study of new service codes to reflect rheumatology care in reimbursement.
• Advance RISE as a tool to advance rheumatology by maximizing its use in MACRA and associated credit in MIPS; reduce barriers to use.
• Support a biosimilars marketplace that provides adequate funding for the FDA, adequate information on drug labels, meaningful suffixes, and protection from inappropriate substitution practices and forced switching.

State Legislative/Regulatory

• Prevent insurance plans from making changes that would negatively impact coverage of patients’ medications during a plan year (non-medical switching).
• Reduce the use and impact of step therapy formulary practices by all payers; support expeditious approval of step therapy exceptions.
• Ensure protection from inappropriate biosimilar substitution practices (e.g. without prior/timely prescriber notification) and forced switching.
• Promote greater awareness of PBMs’ role in drug pricing, and promote increased transparency of PBM practices.
• Streamline prior authorization processes and forms.