Greetings, Advocates!
Great news for the rheumatology community came on Feb. 9, when the Bipartisan Budget Act of 2018 was enacted. It contains several critical healthcare fixes pertinent to rheumatology. First, after hundreds of emails, meetings, letters to the editor, an op-ed, and a forceful 109-member coalition (led by the ACR and including many state and local rheumatology societies) letter to House and Senate leaders, the new law dropped plans for Medicare’s new quality payment program, which would have threatened large cuts to medical practices for providing Part B drugs to patients. Now, Medicare’s Merit-Based Incentive Payment System (MIPS) payment adjustments will not be applied to Part B drug costs, and patients’ access to these treatments will be protected. Also, in a just-in-time victory, the law permanently repealed Medicare’s annual hard cap on rehabilitation therapy services, such as physical therapy, occupational therapy and speech therapy, so our patients can avail themselves of the care they need and stop self-rationing.
The Budget Act also:
- Extended the Children’s Health Insurance Program (CHIP) to 2027;
- Repealed the Independent Payment Advisory Board (IPAB), the unelected board that could have cut Medicare services without Congressional approval);
- Made plans to close the Medicare Part D “donut hole” in 2019, a year early;
- Increased National Institutes of Health funding by $2 billion; and
- Reopened the U.S. government until March 23.
One downside: The law reduced doctors’ promised 2019 pay raise from 0.5% to 0.25%.
Meanwhile, in other legislative news, Congress is still debating whether to continue the Deferred Action for Childhood Arrivals (DACA) policy—which could provide legal status for immigrants, many of whom may become doctors who will eventually care for 100,000 American patients—and whether to authorize Obamacare insurance market stabilization payments. The ACR supports these initiatives.
New Medicare Threats
Right after we heard the great news that MIPS will no longer apply payment adjustments to Part B drug costs, the Trump administration announced possible new proposals that could again threaten patients’ access to some of the same critical drugs. Details appear vague, but here are the four main ideas:
- Allow Part D plans to restrict formularies more often;
- Move Part B drugs into Part D (read: prior authorization delays, high co-pays, donut hole);
- Reduce reimbursement margin for Part B from 6% (actually, 4.3% with sequester) to 3%; and
- Change reimbursement to be unrelated to drug prices.
The ACR is reaching out to the CMS and our coalition partners to gather more information about these possible proposals. Your advocacy team stands ready to work with Congress and Health and Human Services Secretary Azar’s office to protect all the different therapy options that our patients depend on, including access to Part B drugs. The good news is that the administration has signaled plans to:
- Pass drug rebate payments along to patients;
- Reduce Part D out-of-pocket costs; and
- Reduce pharmacy benefit manager (PBM) consolidation.
High Drug Costs
Obviously, most of these policy ideas relate to the high costs of rheumatology treatments and their effects on individual patients and society. As I’ve said before, there is wide agreement that drug prices are too high. The ACR’s strategy to address the high costs of treatments is a two-pronged approach, involving the drug-pricing system on one hand and biosimilars on the other.
Regarding the drug-pricing system: The ACR encourages lawmakers and regulators to address the problems of the PBM–pharma relationship, in which rebate payments encourage higher prices, not lower prices. The good news: Lawmakers are acting. Congress continues to look into PBMs; 17 state bills have been introduced; and on Feb. 23, Virginia passed the country’s first PBM legislation of 2018.
Regarding biosimilars: The ACR, alongside state and federal lawmakers, advocates for a smooth transition to an era of less expensive biologics that provide safe, effective treatments that are accessible to more people. Also, in order to provide useful educational content, on Feb. 7, the ACR published a biosimilars white paper in Arthritis & Rheumatology. It was an honor to participate in this project, with the aim of providing information on the scientific, clinical and economic issues surrounding biosimilars. The ACR biosimilars white paper is open access—please read and share it.
Regulatory Advocacy
Aside from your advocacy team’s efforts on Capitol Hill, I’m glad to report that the ACR has expanded its efforts to influence federal agencies, such as the HHS, CMS and FDA, on behalf of our profession and our patients. In 2017, the ACR more than doubled the number of letters submitted to federal agencies. Topics varied. Example: As Congress appears to be backing off from overarching efforts to repeal and replace Obamacare, the Trump administration continues to propose regulatory reforms that will affect our patients’ access to continuous health insurance and coverage for important services and treatments. The ACR has written several letters to federal policymakers thus far in 2018 about promoting healthcare choice and competition and reducing out-of-pocket costs for prescriptions. We also supported the FDA’s plan to close a loophole in drug development for pediatric orphan diseases. You can check out the ACR letters to the U.S. government here.
Committee Volunteer Acknowledgments
I would like to give shout-outs to all of our dedicated volunteers, including the following:
- Tamar Rubenstein, MD, Chris Morris, MD, Ethan Craig, MD and Chris Phillips, MD, and Ms. Karla Jones, RN, MS, CPNP, along with other ACR leaders, who comprise a new working group that write the comment letters to federal agencies described above;
- Zach Wallace, MD, the ACR’s Government Affairs Committee (GAC) liaison to the ACR Annual Meeting Planning Committee, is putting together another can’t-miss advocacy program for the 2018 Annual Meeting in Chicago; and
- Ethan Craig, MD, Christina Downey, MD, Stephanie Ott, MD and Chap Sampson, MD, led GAC’s annual health policy update, which the ACR Board of Directors approved on Feb. 24. Check out the updated section on MACRA, PBMs, biosimilars and more.
Build RheumPAC & the Foundation
There are two ways you can help ensure the future of our profession: Invest in RheumPAC, which provides your advocacy team with critical relationships in Washington, D.C., and the Rheumatology Research Foundation, which, as you may know, is the largest private funder of rheumatology research and also funds much of the training for our future workforce. Donate today.
P.S.: Don’t forget to check out the Senate testimony of William F. Harvey, MD, MSc, FACR: From Joint Pain to Pocket Pain: Cost and Competition Among Rheumatoid Arthritis Therapies. His remarks start at 35:30 into the video.
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.
