In response to agency requests for public feedback, the ACR has recently called for the removal of multiple federal healthcare regulations that increase administrative burden on rheumatology practitioners.
Along with other executive level agencies, the Centers for Medicare & Medicaid Services (CMS) and the Office of Management & Budget (OMB) published Requests for Information (RFI) in April asking for public feedback on how to streamline regulations and reduce administrative burden on Medicare program stakeholders and small business owners, respectively. These RFIs came on the heels of multiple executive orders released by the Trump administration calling for the elimination of administrative waste and the promotion of agency efficiency, including one order that called for 10 regulations to be removed for every new regulation put on the books.
Although the CMS and OMB RFIs focused on different stakeholders, the ACR used both opportunities to call for the removal of certain regulations related to prior authorization, pharmacy benefit managers (PBMs) and Medicare Part B and Part D access. Burdensome regulations significantly impact practice owners by increasing administrative costs, reducing practice income and ultimately affecting the financial viability of independent practices. These regulations consume a substantial amount of practice resources, diverting time and money away from patient care. As a result, they can lead to increased administrative overload, burnout and a decline in the number of self-employed physicians.
In its response, the ACR called for the following:
- The streamlining of prior authorization (PA) requirements in Medicare Advantage and Medicare Part D plans;
- The elimination of PA for medications that do not have an equally effective alternative;
- The option for providers to submit a PA electronically;
- The removal of step therapy requirements;
- The removal of PBM rebates from the average sales price methodology for biosimilars; and
- The removal of the safe harbor exemptions applied to rebates or flat fee arrangements paid by drug manufacturers to PBMs.
The ACR is committed to ensuring rheumatologists are able to provide high-quality care without being burdened by unnecessary regulations. Although some regulations are necessary to maintain the integrity of the healthcare system, others are counterproductive to providing high-quality care to everyone. The ACR will continue to push for the removal of onerous federal regulations and to ensure that any proposed regulation is adequately tailored toward the ultimate purpose of expanding high-quality care to as many people as possible.
ACR/ARP members can email the ACR’s advocacy team at [email protected] with any questions or comments.
