On Friday, Nov. 19, the U.S. House of Representatives passed the Build Back Better Act, sweeping legislation that includes many provisions impacting healthcare and the rheumatology community. The legislation now goes to the Senate, where it is expected to undergo dramatic changes.
Key Healthcare Provisions
The ACR is supportive of several healthcare provisions included in the version of the Build Back Better Act passed by the House of Representatives. These policies would support the rheumatology community and help patients across the country more easily secure access to quality care. The most notable of these provisions will:
- Fund 5,000 additional Medicare graduate medical education (GME) training slots;
- Require pharmacy benefit managers to report compensation, costs, fees and rebates every six months to group health plan sponsors;
- Negotiate a maximum fair price for select treatments under Medicare;
- Mandate rebates for prescription drug cost inflation that exceeds certain benchmarks;
- Cap out-of-pockets costs to Medicare patients at $2,000 annually;
- Cap monthly cost-sharing payments for Medicare users of certain prescription drug plans;
- Provide $500 million to support qualifying medical schools; and
- Expand funding for public health systems and GME.
Potential Unintended Consequence
The ACR has long held the positions that Medicare should be able to negotiate with pharmaceutical companies and that patients’ out-of-pocket costs should be capped to make drugs more affordable. We applaud Congress’ efforts to lower healthcare costs and will work with the Senate to preserve items in the legislation that benefit patient access to quality care. However, we are also communicating our concerns about some potential unintended consequences of certain drug pricing provisions that put physicians and their patients in the middle of the proposed “negotiation” between the government and drug manufacturers.
Specifically, the bill as passed by the House risks unsustainable cuts to Medicare reimbursements to providers who administer drugs covered by Medicare Part B, who must prepay manufacturers to acquire these treatments before they are administered in order to provide timely care to patients with serious diseases. While the maximum fair price would be set by Congress, concessions after the point of sale could result in providers being reimbursed less than they paid to acquire the drug. The ACR will urge the Senate to modify the drug pricing provisions to require drug manufacturers to directly refund to the federal government excess costs above the negotiated “maximum fair price” plus 6%. Refunds or discounts that are provided by manufacturers directly to the federal government should be exempted from the manufacturer’s calculation of the average sales price so provider payments are not artificially reduced.
Like past policies that decreased Medicare Part B reimbursements without considering the way in which physicians must acquire the treatments, the new bill could cause consolidation or closure of independent practices and force patients to seek care in more expensive settings. This may threaten access to care and result in many patients having to pay more for drugs and medical care—the opposite of what Congress intends. This is particularly true for elderly Medicare recipients living in rural areas, who already face significant barriers to care. The goals of the Build Back Better Act, though admirable, are not served by the current wording that may cause patients to travel farther for care or seek care in more expensive settings.
For these reasons, the ACR will be working with Senate offices to continue to support Medicare negotiation in both Part D and Part B but will be asking that the new Part B drug price negotiations cap the actual price of the drugs, not reimbursement to physicians who have already purchased these expensive treatments for their patients. Negotiation and direct capping of drug prices, not reimbursement, will be a win for patients, healthcare access and Medicare.
