Greetings from Washington, D.C. Your advocacy team had another busy month. Unlike my prior updates, and in order to keep our focus on health policy, I avoid mentioning anything about Washington investigations into obstruction of justice, collusion, etc. You get enough of that elsewhere.
The Healthcare Bill
Obamacare repeal and reform efforts are speeding up. As many of you know, the House passed a bill repealing and replacing components of Obamacare (see my #simpletasks update here). The Senate did not hold public hearings on its version of the healthcare bill, but like the House, wrote the bill in secret, as The New York Times reported. The ACR notified Senate leadership through letters and more than 100 in-person meetings in May about how best to protect the interests of our patients and our profession. We’re currently following up on those contacts.
Meanwhile, everyone reading this can easily send a prewritten, editable letter to their senators by visiting the ACR’s Legislative Action Center and clicking on “take action.” It takes just a minute—and now is the perfect time. Your leaders need to hear your voice.
Trump’s Skinny Budget for FY18
The ACR joined with many health advocates in opposing the Trump administration’s proposals for sweeping cuts to NIH, Medicaid, CHIP and taxpayer funding of FDA. Of note, budget proposals are just that—proposals—and Congress ultimately decides the federal budget. Thankfully, many members of Congress oppose Trump’s cuts. But Trump has created a tone of spending cuts. Meanwhile, the ACR does endorse two rheumatology-friendly parts of the budget, those that would boost funding for graduate medical education and repeal IPAB, the Medicare-cutting mechanism.
As Congress begins the budget process, your advocacy team has also established strong support for a new, dedicated arthritis funding stream through the Department of Defense (DoD). Take a minute to send an email to your member of Congress asking them to repeal IPAB and support arthritis research (go here and click on “7 advocacy campaigns” or Google “rheumatology legislative action center”).
ACR Helps Reduce Administrative Burdens
The ACR recently met with leaders of Health and Human Services (HHS) and also sent a letter to CMS Administrator Seema Verma, requesting regulatory relief to reduce administrative burdens. We advocated for modifying billing codes to reflect the value of rheumatology care, improving transparency in the way the CMS makes rules and making both tracks of MACRA (MIPS and APMs) more feasible for rheumatologists. Read the letter here.
Speaking of APMs, if you are aware of the possible reimbursement cuts to Medicare providers coming through MIPS, you may be interested in how a rheumatology-related APM may allow you to avoid them. For several months, a team of your fellow ACR volunteers has been designing an APM for this purpose. The team is focusing on RA, and the experience may lead to APM tracks for other disease states. Stay tuned.
Biosimilars
The ACR commented on the FDA’s proposed interchangeable pathway in late May. Your advocacy team strongly supports the FDA’s proposal for interchangeable biosimilar clinical trials to switch patients between a reference drug and its biosimilar at least three times (A-B-A-B) to prove safety and efficacy. The College also came out in support of meaningful suffixes that would make biosimilar names more memorable and easier to work with. The Biosimilars Prescribers Collaborative released a succinct white paper on biosimilars with great information and advocacy points; the ACR contributed to this document, and I highly recommend reading it. My recent op ed details some of the current issues and salient points about interchangeability. Stay tuned for an ACR white paper on biosimilars coming later this summer/fall.
#ACR2017
As we learn of the scientific findings coming out of the European League Against Rheumatism (EULAR) 2017 Congress this past week, we’re reminded that the 2017 ACR/ARHP Annual Meeting is just around the corner. Unfortunately, due to the new extreme vetting of visitors to the U.S., the ACR, like other organizations, is anticipating a possible drop in international attendees at the meeting. To help mitigate this issue, the ACR offers a website with tips and information for international travelers. Please spread the word to your international colleagues and friends—and keep the ACR’s meeting strong and fruitful.
Coalition Challenges PBMs
The ACR has joined the Alliance for Transparent & Affordable Prescriptions, a coalition dedicated to transparency for pharmacy benefit managers. Congress is holding hearings on PBMs and the drug pricing system—as the major industry stakeholders start pointing fingers at each other. Recently, coverage has increased in the press and medical literature. See topical stories in the following publications (apologies for the paywalls): the Journal of the American Medical Association, The New York Times, The Wall Street Journal and The Washington Post.
MedPAC Déjà Vu
MedPAC, the independent U.S. federal policy commission, is at it again. It has proposed a reduction in reimbursement for Medicare Part B drug administration services and allowing companies to create prior authorization programs and other barriers to Medicare treatments. In response, the ACR and many state rheumatology societies sent a letter to HHS Secretary Price urging him not to adopt the recommendations. The ACR’s advocacy team is watching this closely and will respond forcefully—with your help—if CMS begins to adopt any of these plans.
Join the AMA (I Really Mean It)!
The American Medical Association’s House of Delegates voted recently to approve the ACR’s resolution asking the federal government to allow international physicians to have visas processed quickly so they can take care of underserved U.S. patients. Subsequently, the Trump administration made the requested changes just in time for physicians finishing training to apply. The ACR’s ability to propose resolutions on issues related to patient care, our workforce shortage, reimbursement, administrative hassles, etc. is contingent upon having enough ACR members join the AMA. Go here to join or renew your AMA membership.
Thanks for reading. Don’t forget to invest in RheumPAC and make your voice heard on Capitol Hill.
Angus Worthing, MD, FACP, FACR, Chair, Government Affairs Committee, is a practicing rheumatologist in the Washington, D.C., metro area and clinical assistant professor of medicine at Georgetown University.
