Congress: Act now to safeguard patients’ access to Part B treatments
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Congress operates with good intentions; it is the good-faith pact it has with America’s citizens. However, when a well-meaning legislative framework ends up harming those it is meant to help due to flawed implementation, our elected lawmakers must correct course. 

When those policies negatively impact the health and well-being of millions of Americans, Congress must go a step further: it must act swiftly.

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Less than a month from now, our nation’s Medicare patients who receive specialty drug treatments in a doctor’s office or another outpatient setting could be at risk of losing access to these vital therapies. This is because in its 2018 Quality Payment Program final rule, the Centers for Medicare and Medicaid Services (CMS) announced that it will immediately begin applying the Merit-based Incentive Payment System (MIPS) adjustments to Part B drug payments.

While the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is intended to promote quality and value in the American healthcare system, in this case CMS is interpreting the law in a way that will compromise patient access to therapies while creating significant financial uncertainty for providers. According to a troubling analysis from Avalere Health, some specialists could see payment cuts as high as 29 percent by 2020 if Part B drug spending is included in the calculation for their quality-program payment adjustments. Such a drastic payment swing will create extreme volatility for specialists who administer Part B drugs.

If CMS’ policy changes are implemented as planned, Medicare patients who rely on Part B drug coverage – including those under the care of rheumatologists for severe conditions, and those cared for by ophthalmologists and at risk of losing their vision – will be put in very real jeopardy. Thousands of specialty providers – including many rheumatologists and ophthalmologists– will be forced into an impossible position. Some physicians will be asked to choose between serving an economically viable community, or risk the operational viability of their practice. 

Either way, patients lose. With providers unable to shoulder the financial burden of obtaining and administering these expensive drugs, many patients will be forced to seek treatment in much more expensive and inconvenient settings – if they can access these therapies at all.  

Unlike prescription drugs, Part B drugs cannot simply be purchased at the local pharmacy. These complex therapies require the skill and knowledge of specialists to administer them through injection or infusion, as well as follow-up monitoring for adverse side effects. Often, the physician’s office is not only the most cost-effective site of care for Part B drug infusions – it can be the only available place to safely receive such care. 

No Medicare beneficiary should encounter significant access issues to the therapies on which they rely. Yet despite warnings from congressional leaders on both sides of the aisle, CMS has decided to move forward with this major change that also represents a drastic departure from current policy. CMS has not historically included doctor-administered drug costs in its value and quality program payment calculations – and rightly so. Restricting Medicare patients’ access to vital therapies is not the way to achieve the value and quality MACRA was intended to deliver.

Congress must act quickly to find a legislative solution clarifying that Part B drug spending will not be applied to MIPS payment adjustments.  We urge lawmakers to move swiftly to protect our patients’ access to the drug therapies they need and deserve.   

David Daikh, MD, Ph.D., is President of the American College of Rheumatology. Cynthia A. Bradford, MD, is President of the American Academy of Ophthalmology.