ACR ‘concerned’ over recommended cuts to Medicare Part B infusion reimbursement
Click Here to Manage Email Alerts
Key takeaways:
- The ACR is criticizing proposed cuts to physician reimbursements for infused therapies.
- Reimbursement changes may impact quality of care through reduced therapy options, the ACR warned.
The American College of Rheumatology is sounding the alarm over a recent recommendation from the Medicare Payment Advisory Commission — or MedPAC — that it says would cut physician reimbursements for infused therapies.
According to the ACR, MedPAC has recommended “yet another” cut to physician reimbursement for infusions as part of its June 2023 Report to the Congress: Medicare and the Health Care Delivery System. In a letter to the commission, ACR officials criticized a recommendation that Congress maintain a 6% add-on payment for the lowest-cost drugs, reduce the add-on payment for mid-to-high-level drugs, and add a payment cap for the costliest drugs.
“While we support efforts to rein in the cost of prescription drugs, we firmly believe that this policy would jeopardize provider practices and patients’ health by reducing access to life-changing provider-administered therapies,” ACR President Douglas White, MD, PhD, said in a press release. “We urge Congress to address the high cost of drugs at the root cause, like the opaque pharmacy benefit manager business practices, and not at the expense of providers.”
According to the release, MedPAC’s recommendation to cut physician reimbursements related to infusion therapies stemmed from the assertion that providers prescribe and administer the most expensive therapies in an effort to receive as much reimbursement as possible.
“ACR firmly rejects this premise,” the release said. “Administering Medicare Part B drugs in provider offices requires rheumatologists to buy the drug in bulk, maintain full-time staff to administer the treatment, and only bill Medicare after it has been given to the patient.”
The ACR additionally argued that the 6% of the average sales price add-on does not incentivize high-cost treatments, but rather makes acquiring, storing and administering these treatments feasible. If the current recommendations put forth by MedPAC were to be instituted, rheumatologists would need to provide care at a loss or reduce the range of therapies they offer, the release said.
“As providers, it is our job to prescribe the most appropriate treatment for our patients,” Christina Downey, MD, chair of the ACR’s Government Affairs Committee, said in the release. “The add-on payments are not considered in our clinical decision-making. We are concerned that policymakers are concentrating on these add-on payments rather than focusing on policies that address the true cause of drug prices.
“The ACR will always express concern when provider payments to administer drugs are eschewed by widely supported policies,” she added. “Hopefully, the bipartisan movement to reform the PBMs industry will yield meaningful change, and patients will see the benefits.”
Click Here to Manage Email Alerts