ACR Urges Reforms by HHS Save

Dr. David Daikh, president of the American College of Rheumatology (ACR) has written a letter to the Department of Health and Human Services (HHS) in response to their Request for Information on Promoting Health Care Choice and Competition Across the United States.  

In this letter he addresses key concerns of US Rheumatologists, inluding:

• ACR continues to be highly concerned about Medicare Part B drug payments being subject to the Merit-Based Incentive Payment System (MIPS) payment adjustments.
• ACR supports reevaluation of the Stark law policies against physician self-referral in order to align new health care delivery models with value-based and shared risk reimbursement models.
• ACR has applauded CMS’ decision to revise its policy for reimbursing biosimilars under the Medicare Part B program as a part of the 2018 Physician Fee Schedule Final Rule and supports assigning a unique J-code to each biosimilar of a particular reference product, so that physicians can better track and monitor their effectiveness and ensure adequate pharmacovigilance in the area of biosimilars.
• The problem of prior authorization - The ACR endorsed 21 Prior Authorization and Utilization Management Reform Principles that are intended to serve as best practices and reasonable reforms for utilization management (UM) programs
• ACR has concerns regarding the practices of pharmacy benefit managers (PBMs).The PBM industry is overly consolidated with the two largest PBMs covering more than 170 million Americans. ACR requests that PBMs be more transparent about their payment practices, including transparency around the true cost of prescription drugs
• ACR is concerned about eliminating the cost sharing reduction (CSR) measures may reduce low-income patients’ access to health insurance, thus making it difficult for them to access the care they require. Rheumatic diseases are life-long, chronic conditions that require continuous health insurance coverage that encourages high quality care.