ACR Praises Congress for Bill with Part B Fix, Therapy Caps Repeal

The ACR praises Congressional leaders for passing the sweeping spending agreement, which includes a technical provision reversing a Centers for Medicare & Medicaid Services (CMS) policy that would have linked physicians’ quality payment adjustments to Medicare Part B drug costs starting in 2019. The ACR also applauds the inclusion of provisions that permanently repeal Medicare caps on outpatient therapies and other rehabilitation services, repeal the Independent Payment Advisory Board (IPAB) and eliminate the Medicare Part D donut hole.

“The healthcare provisions included in the spending agreement are a huge victory for the more than 54 million Americans living with rheumatic diseases, many of whom rely on biologic therapies and vital rehabilitation services to manage their disease,” said ACR President David Daikh, MD, PhD. “We thank Congressional leaders for coming together swiftly and in a bipartisan fashion to ensure that Americans living with diseases like rheumatoid arthritis can access the infusion therapies and rehabilitation services that help them avoid disability and maintain quality of life. This victory would not have been possible without the efforts of the many rheumatologists and rheumatology health professionals throughout the nation who voiced their concerns to lawmakers and brought attention to these incredibly important issues.”

The Part B technical correction in the spending bill comes after the ACR and more than 100 other healthcare groups urged Congressional leaders to step in and reverse course on a CMS policy that would have created extreme financial volatility for specialists who administer Part B drugs and would have made it more difficult for patients—particularly those living in rural and underserved areas of the country—to access physician-administered infusion therapies.

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According to an analysis from Avalere Health, certain specialists who administer Part B drugs—including rheumatologists, oncologists and ophthalmologists—would have seen payment cuts as high as 29% under the CMS policy to factor Part B drugs in Merit-Based Incentive Payment System payment calculations, compromising the ability of some providers to continue administering complex infusion therapies in the office setting.

The current Part B drug payment structure already makes it difficult for providers—particularly small practices and those operating in rural areas—to shoulder the financial burden of procuring and administering Part B drugs. Infusion therapies covered by the Part B program are often expensive, with few or no generic alternatives, and providers have been subjected to repeated Part B reimbursement cuts over the past decade.