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Medicare and Medicaid Services Not to Go Forward With Part B Payment Proposal

  • Published: 2016-12-17 : Author: American College of Rheumatology : Contact: rheumatology.org
  • Synopsis: Medicare beneficiaries living with rheumatic diseases are able to continue receiving therapies to manage their chronic conditions and avoid pain and disability.

Quote: "For older Americans living with painful and debilitating diseases like rheumatoid arthritis, lupus, spondyloarthritis, and psoriatic arthritis, safe access to biologic therapies is not an option but a necessity..."

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The American College of Rheumatology (ACR) applauds the decision from the Centers for Medicare & Medicaid Services (CMS) not to go forward with the agency's controversial Part B payment proposal, noting that the hard-fought outcome is good news for rheumatology patients who rely on Medicare Part B to access life-saving biologic therapies.

"We thank CMS for listening to the rheumatology community's concerns about the negative and disproportionate impact this proposal would have on our Medicare patients living with rheumatic diseases by not moving forward with this Part B Demonstration Project," said Dr. Sharad Lakhanpal, MBBS, MD, President of the ACR. "For older Americans living with painful and debilitating diseases like rheumatoid arthritis, lupus, spondyloarthritis, and psoriatic arthritis, safe access to biologic therapies is not an option but a necessity - which is why the ACR has been vocal in expressing our concerns about the unintended consequences of this proposal and its flawed cost-savings premise. This positive outcome will help ensure Medicare beneficiaries living with rheumatic diseases are able to continue receiving the therapies they need to manage their chronic conditions and avoid pain and disability."

From the time it was proposed in March 2016, the ACR has voiced strong opposition to the proposed rule. In detailed comments submitted to CMS earlier this year, the ACR expressed concerns about the lack of less expensive yet clinically equivalent biologic therapy options in the marketplace for Medicare patients living with rheumatic diseases, as well as the safety and health dangers posed by switching from a biologic therapy that works well for the patient.

The ACR has also noted that many rheumatologists - particularly small or rural practices that lack the ability to negotiate bulk discounts with pharmaceutical companies - have already been forced to stop administering biologic therapies to Medicare patients because the current Part B payment structure does not cover the costs of obtaining and providing these complex therapies in the outpatient setting. If the additional payment cuts proposed by CMS in the Part B Demonstration Project were to go through, the ACR warned that many rheumatology patients would be forced into less safe or more expensive settings to receive needed therapies, if these patients were able to receive them at all.

More than 52.5 million people - one in five Americans - live with rheumatic diseases, according to the Centers for Disease Control and Prevention (CDC). Rheumatic diseases are the nation's leading cause of disability, contributing more than $128 billion in costs to the U.S. healthcare system each year.

American College of Rheumatology (ACR)

The American College of Rheumatology provides education, research, advocacy and practice management support to more than 6,400 U.S. rheumatologists and rheumatology health professionals. In doing so, the ACR advocates for high-value, high-quality healthcare policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care. For more information, visit http://www.rheumatology.org

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