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ACR, Physician Groups Warn HHS Against New Pricing Proposals for Biologics
The American College of Rheumatology has joined eight other national physician groups in calling on HHS to reconsider a series of new drug pricing proposals, including one that would consolidate some medications covered under Medicare Part B into Medicare Part D, warning they could increase costs and limit access for patients.
In a letter to HHS Secretary Alex M. Azar II, the groups, including the American Academy of Neurology, the American Academy of Opthalmology and the American Urological Association, also warned against a proposal that would reduce physician reimbursements for new drugs below current payment rates. According to the ACR, the proposals could limit access to biologic therapies and force patients to seek treatment at higher-cost sites of care.
“There is universal agreement among rheumatologists that the prices of our complex drugs are too high,” Angus B. Worthing, MD, FACP, FACR, government affairs committee chairman for the ACR, told Healio Rheumatology. “The ACR’s advocacy team stands ready to work with Secretary Azar and officials at HHS to help bring down costs, but much of what has been proposed might threaten our patients’ access to treatments.”
In a press release, the ACR argued that Medicare parts B and D are “distinctly different programs with differing formulary structures and cost sharing,” and that consolidations would significantly increase out-of-pocket costs for patients, particularly those who rely on biologics. In addition, because Medicare Part D does not include supplemental coverage, patients could be responsible for larger portions of expensive biologics, according to the press release.
“It would be unfortunate to see those financial barriers go up for Part B drugs as well,” Worthing said. “We need more details about the proposals to reduce physician reimbursement for providing Part B drugs, but from what we have seen so far, these appear to stem from misconceptions that our biologic drugs have cheaper alternatives. Indeed, the nascent marketplace of biosimilars may be our best hope for less expensive medicines, and the ACR supports the transition to an era of safe, effective biologic treatments that are accessible to all people who need them.”
The groups also warned that changing Medicare Part D formulary standards to require a minimum of one drug per class, rather than the current standard of two, would limit patients’ access to certain medical treatments preferred by their physician.
The ACR also argued against a proposal that would reduce physician reimbursements for in-office treatment from the current Average Sales Price +6% to +3%, which it said could limit patient access.
“By reducing physician reimbursements below the cost of obtaining and providing these complex therapies, many practices — especially small and rural practices that are unable to negotiate bulk discounts from manufacturers — may be forced to stop administering biologic therapies to Medicare patients altogether,” the ACR said in the release. “This would drive patients into more expensive and less convenient settings to receive needed therapies — if such alternatives even exist.”
In conjunction with the other physician groups, the ACR provided HHS with a series of recommendations its said would lower drug prices and increase patient access. They include:
- Require Medicare Part D plans to apply a substantial portion of rebates at the point of sale;
- Create a beneficiary out-of-pocket maximum in the Medicare Part D catastrophic phase, which would provide beneficiaries with better protection against high drug costs;
- Decrease the concentration in the pharmacy benefit manager market and other segments of the supply chain; and
- Provide guidance from CMS on how drug-related value-based contracts and price reporting would affect other price regulations.
“Our organizations are dedicated to ensuring that physicians have the resources they need to provide patients with high-quality care,” read the letter. “We look forward to being a resource to you and we welcome the opportunity to meet with HHS to discuss our concerns and positions in more detail.” – by Jason Laday