“The Part B technical fix is an important course correction that will hopefully lead to productive discussions about how to realistically address the issues of care access and high drug costs,” said Dr. Daikh.
In January, an arbitrary cap was placed on Medicare outpatient therapies and other rehabilitation services 20 years after being approved in the Balanced Budget Act. Congress temporarily prevented the implementation of the caps 16 times before it began limiting access to services on Jan. 1, 2018. A permanent repeal of these caps ends a long battle to allow Medicare patients access to the care they need based on individual circumstances.
Rheumatologists also celebrate the repeal of IPAB, the 15-member appointed board whose recommendations came with a statutorily mandated fast-track legislative procedure that would automatically transform IPAB proposals into law. Such recommendations had the power to impose provider cuts that could disproportionately impact small and rural practices. The ACR is relieved that such policies will undergo the detailed review and deliberation of the regular legislative process in the future.
Since 2006, eligible Medicare beneficiaries have had the option of purchasing a prescription drug benefit plan to cover medications. After meeting their deductible (which was a maximum of $400 for 2017), beneficiaries were responsible for only 25% of the original cost of prescription drugs on their plan’s formulary. However, until changes were made in 2011, patients whose prescription costs were more than $3,700 found themselves in a coverage gap, or donut hole, in which they would be responsible for the full cost of their drugs until they reached an out-of-pocket threshold, which was $4,950 in 2017. After reaching the threshold, patients paid only 5% of their drug costs. The closing of this gap allows patients to access necessary medications and supports the ACR’s goal of access to care and our patients’ ability to adhere to carefully determined treatment plans.
“We applaud Congress for acting to protect patient access to vital therapies and services, and we look forward to working with the Administration and Congressional leaders to ensure patients living with rheumatoid arthritis and other rheumatologic conditions continue to receive innovative, medically necessary and life-sustaining care,” concluded Dr. Daikh.
