Greetings, advocates! This month’s Washington update covers how Congress’s tax proposals affect rheumatology, the ACR’s plan to fight Medicare’s adjustments to Part B drug costs in MIPS, the good news of Medicare’s new individualized biosimilar reimbursement, advances in the rheumatology-specific Alternative Payment Model and developments in Congress’s awareness about the perilous pharmacy benefit manager system.
Senator Addresses ACR
In case you missed it: Sen. Lisa Murkowski (R-Alaska) spoke by video at the 2017 ACR/ARHP Annual Meeting in San Diego about her efforts in Congress to create patient-friendly health reforms. Check out her three-minute talk. The ACR awarded Sen. Murkowski the 2017 Award for Public Leadership in Rheumatology for championing causes critical to the rheumatology community.
Tax Reform Bills
On Nov. 16, the U.S. House of Representatives passed tax legislation repealing waivers that allow grad students to avoid paying tax on tuition assistance grants, which makes higher education tuition grants taxable. This would reduce incentives to go into biomedical research fields and could greatly limit rheumatology research.
Meanwhile, the Senate tax bill keeps those waivers, fortunately, but proposes repealing the Affordable Care Act’s (ACA) individual mandate to buy insurance. The Congressional Budget Office (CBO) estimates that such a move on its own could cause 13 million people to lose insurance. The ACR released a statement urging Congress to protect the tax waivers for graduate student tuition and to support continuous health insurance coverage.
Finally, and of dire concern to us, the CBO also estimated that these tax reforms may increase the deficit, triggering further sequester cuts—up to 4% more in Medicare payments. The ACR is actively monitoring this fast-moving development.
The Part B Perfect Storm
Challenging news: On Nov. 2, the Centers for Medicare and Medicaid Services (CMS) finalized a plan to adjust Part B drug costs in the MIPS program starting in 2020 based on 2018 performance. This means providers of our expensive drugs may be at risk of reimbursement cuts that could be as high as 5% of those high drug costs—and that percentage will grow to 9% over three years. This could potentially bankrupt a practice that passes through those drug costs with a 4% margin and would therefore severely limit patients’ access to treatment.
The ACR advocacy team has already voiced our strong opposition to the Congressional committees responsible for fixing the problem of MIPS adjusting Part B drug costs, and we are now working with coalition partners (oncology, ophthalmology, gastroenterology, urology, other physician specialties, and patient groups) to leverage our message. We’ll soon have information available in the Legislative Action Center on how you can get involved.