In a powerful op-ed published by Fierce Healthcare, rheumatologists Amanda Myers, MD, and Rebecca Shepherd, MD, MBA—both volunteer advocates with the ACR—highlighted the critical role of the Centers for Medicare & Medicaid Services (CMS) in improving access to life-changing medications for patients with autoimmune and rheumatic diseases.
Many patients with chronic conditions, such as rheumatoid arthritis, psoriatic arthritis and scleroderma, face steep financial barriers to accessing necessary treatments. High drug prices often lead to skipped doses, delayed care and preventable hospitalizations. The Inflation Reduction Act (IRA), passed in 2022, empowered the CMS to negotiate prices for 70 medications, with plans to expand to more in the coming years.
Two drugs—Otezla (apremilast) and Ofev (nintedanib)—were selected in the second round of negotiations. These medications are vital for tens of thousands of Medicare beneficiaries managing painful and progressive rheumatologic conditions. Their inclusion in the negotiation program is a major step toward affordability and adherence.
Drs. Myers and Shepherd shared firsthand accounts of how these medications improve quality of life. Otezla, for example, offers a convenient oral alternative to infusions, helping patients maintain treatment schedules despite logistical challenges. Ofev, used to treat autoimmune-associated lung disease, can significantly extend life expectancy when accessible.
However, the op-ed also raises concerns about unintended consequences. Under the IRA, reimbursement for physician-administered Part B drugs may fall below cost, potentially forcing infusion centers to discontinue services. Legislation like the Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299) aims to correct this by restoring fair reimbursement standards.
The authors also called attention to the role of pharmacy benefit managers (PBMs) in driving up drug costs through opaque pricing and rebate structures. They urged lawmakers to pursue transparency reforms that prioritize patients over profits.
As the CMS continues its drug price negotiation efforts, the rheumatology community remains engaged and hopeful. The ACR’s participation in CMS town halls and advocacy efforts underscores the importance of clinician voices in shaping policy that directly affects patient care.
“While we must attend to budgets and balance sheets,” the authors wrote, “human life is priceless.”
For more on the ACR’s advocacy work and how you can get involved, visit https://www.rheumatology.org/about-acr-advocacy.
