Great news for the rheumatology community came on Feb. 9, when the Bipartisan Budget Act of 2018 was enacted. It contains several critical healthcare fixes pertinent to rheumatology. First, after hundreds of emails, meetings, letters to the editor, an op-ed, and a forceful 109-member coalition (led by the ACR and including many state and local rheumatology societies) letter to House and Senate leaders, the new law dropped plans for Medicare’s new quality payment program, which would have threatened large cuts to medical practices for providing Part B drugs to patients. Now, Medicare’s Merit-Based Incentive Payment System (MIPS) payment adjustments will not be applied to Part B drug costs, and patients’ access to these treatments will be protected. Also, in a just-in-time victory, the law permanently repealed Medicare’s annual hard cap on rehabilitation therapy services, such as physical therapy, occupational therapy and speech therapy, so our patients can avail themselves of the care they need and stop self-rationing.
The Budget Act also:
- Extended the Children’s Health Insurance Program (CHIP) to 2027;
- Repealed the Independent Payment Advisory Board (IPAB), the unelected board that could have cut Medicare services without Congressional approval);
- Made plans to close the Medicare Part D “donut hole” in 2019, a year early;
- Increased National Institutes of Health funding by $2 billion; and
- Reopened the U.S. government until March 23.
One downside: The law reduced doctors’ promised 2019 pay raise from 0.5% to 0.25%.
Meanwhile, in other legislative news, Congress is still debating whether to continue the Deferred Action for Childhood Arrivals (DACA) policy—which could provide legal status for immigrants, many of whom may become doctors who will eventually care for 100,000 American patients—and whether to authorize Obamacare insurance market stabilization payments. The ACR supports these initiatives.
New Medicare Threats
Right after we heard the great news that MIPS will no longer apply payment adjustments to Part B drug costs, the Trump administration announced possible new proposals that could again threaten patients’ access to some of the same critical drugs. Details appear vague, but here are the four main ideas:
- Allow Part D plans to restrict formularies more often;
- Move Part B drugs into Part D (read: prior authorization delays, high co-pays, donut hole);
- Reduce reimbursement margin for Part B from 6% (actually, 4.3% with sequester) to 3%; and
- Change reimbursement to be unrelated to drug prices.
The ACR is reaching out to the CMS and our coalition partners to gather more information about these possible proposals. Your advocacy team stands ready to work with Congress and Health and Human Services Secretary Azar’s office to protect all the different therapy options that our patients depend on, including access to Part B drugs. The good news is that the administration has signaled plans to:
- Pass drug rebate payments along to patients;
- Reduce Part D out-of-pocket costs; and
- Reduce pharmacy benefit manager (PBM) consolidation.
High Drug Costs
Obviously, most of these policy ideas relate to the high costs of rheumatology treatments and their effects on individual patients and society. As I’ve said before, there is wide agreement that drug prices are too high. The ACR’s strategy to address the high costs of treatments is a two-pronged approach, involving the drug-pricing system on one hand and biosimilars on the other.