Kelly April Tyrrell writes about health, science and health policy. She lives in Madison, Wis.
You Might Also Like
Also By This Author
- 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.
- 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.
- 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.
- 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.
- 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.