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White House proposals to help lower drug prices are being met with concerns by a group of specialists.
In a March 14 letter to Department of Health & Human Services Secretary Alex Azar, a group of nine specialty medical organizations highlighted four recent proposals that could have an unintended consequence of limiting access.
The specialty groups that signed onto the letter are the American Academy of Dermatology Association, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Physical Medicine and Rehabilitation, American College of Gastroenterology, American College of Rheumatology, American Gastroenterological Association, American Urological Association, and the Infectious Diseases Society of America.
The groups focused on issues pertaining to four proposals highlighted in the White House’s proposed fiscal year 2019 budget and the February 2018 report from the Council of Economic Advisors titled, “Reforming Biopharmaceutical Pricing at Home and Abroad.”
The first proposal relates to changing the requirement that Medicare Part D prescription drug plans cover at least two drugs per category to covering only one as a way to provide more flexibility and potential negotiation power, while at the same time expanding the ability to use utilization management tools.
“We worry this could create access issues for patients on high cost biologic medications,” the groups said in the letter. “We believe Part D benefits should not limit patients’ access to the medical therapy judged by the treating physician to be the most efficacious choice.”
“We worry that moving Part B drugs into Part D may lead to access issues and force patients into higher cost sites of care,” the groups said.
Third, the White House is proposing to cut Part B drug reimbursement to physicians from the current average sales price plus 6% down to ASP+3% for new drugs.
The groups said that with the budget sequestration currently in place, “the existing Part B payment structure does not adequately cover the costs of obtaining and providing these complex therapies in an outpatient setting. If additional payment cuts or negative changes are implemented or activated through demonstration projects, many patients would be forced into more expensive, less convenient settings to receive their therapies – if an alternative setting is available at all in their areas.”
Finally, the groups mention a proposal that would introduce physician reimbursement that is not tied to drug pricing. But this option is not expanded upon in the Council of Economic Advisors report.
“We request more clarity on any potential policies that would affect physician reimbursement,” the groups said. “Physicians have no control over the cost of drugs or ancillary services, nor over the severity of illness and comorbidities that drive the need for such services.”
The groups did support a few of the recommendations from the two documents, including requiring Medicare Part D plans to apply a substantial portion of the rebate at point of sale, establishing a Part D out-of-pocket maximum in the catastrophic phase to better protect beneficiaries against high drug costs, decreasing the consolidation by pharmacy benefit managers and others in the supply chain, and providing the Centers for Medicare & Medicaid Services with guidance on how drug-related value-based contracts and price reporting would affect other price regulations.
“We appreciate HHS’ continued focus on transparency and patient-centered care,” the groups said. “Knowing that HHS is committed to transforming the health care delivery system and the Medicare program by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improving outcomes, is reassuring to our providers.”
White House proposals to help lower drug prices are being met with concerns by a group of specialists.
In a March 14 letter to Department of Health & Human Services Secretary Alex Azar, a group of nine specialty medical organizations highlighted four recent proposals that could have an unintended consequence of limiting access.
The specialty groups that signed onto the letter are the American Academy of Dermatology Association, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Physical Medicine and Rehabilitation, American College of Gastroenterology, American College of Rheumatology, American Gastroenterological Association, American Urological Association, and the Infectious Diseases Society of America.
The groups focused on issues pertaining to four proposals highlighted in the White House’s proposed fiscal year 2019 budget and the February 2018 report from the Council of Economic Advisors titled, “Reforming Biopharmaceutical Pricing at Home and Abroad.”
The first proposal relates to changing the requirement that Medicare Part D prescription drug plans cover at least two drugs per category to covering only one as a way to provide more flexibility and potential negotiation power, while at the same time expanding the ability to use utilization management tools.
“We worry this could create access issues for patients on high cost biologic medications,” the groups said in the letter. “We believe Part D benefits should not limit patients’ access to the medical therapy judged by the treating physician to be the most efficacious choice.”
“We worry that moving Part B drugs into Part D may lead to access issues and force patients into higher cost sites of care,” the groups said.
Third, the White House is proposing to cut Part B drug reimbursement to physicians from the current average sales price plus 6% down to ASP+3% for new drugs.
The groups said that with the budget sequestration currently in place, “the existing Part B payment structure does not adequately cover the costs of obtaining and providing these complex therapies in an outpatient setting. If additional payment cuts or negative changes are implemented or activated through demonstration projects, many patients would be forced into more expensive, less convenient settings to receive their therapies – if an alternative setting is available at all in their areas.”
Finally, the groups mention a proposal that would introduce physician reimbursement that is not tied to drug pricing. But this option is not expanded upon in the Council of Economic Advisors report.
“We request more clarity on any potential policies that would affect physician reimbursement,” the groups said. “Physicians have no control over the cost of drugs or ancillary services, nor over the severity of illness and comorbidities that drive the need for such services.”
The groups did support a few of the recommendations from the two documents, including requiring Medicare Part D plans to apply a substantial portion of the rebate at point of sale, establishing a Part D out-of-pocket maximum in the catastrophic phase to better protect beneficiaries against high drug costs, decreasing the consolidation by pharmacy benefit managers and others in the supply chain, and providing the Centers for Medicare & Medicaid Services with guidance on how drug-related value-based contracts and price reporting would affect other price regulations.
“We appreciate HHS’ continued focus on transparency and patient-centered care,” the groups said. “Knowing that HHS is committed to transforming the health care delivery system and the Medicare program by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improving outcomes, is reassuring to our providers.”
White House proposals to help lower drug prices are being met with concerns by a group of specialists.
In a March 14 letter to Department of Health & Human Services Secretary Alex Azar, a group of nine specialty medical organizations highlighted four recent proposals that could have an unintended consequence of limiting access.
The specialty groups that signed onto the letter are the American Academy of Dermatology Association, American Academy of Neurology, American Academy of Ophthalmology, American Academy of Physical Medicine and Rehabilitation, American College of Gastroenterology, American College of Rheumatology, American Gastroenterological Association, American Urological Association, and the Infectious Diseases Society of America.
The groups focused on issues pertaining to four proposals highlighted in the White House’s proposed fiscal year 2019 budget and the February 2018 report from the Council of Economic Advisors titled, “Reforming Biopharmaceutical Pricing at Home and Abroad.”
The first proposal relates to changing the requirement that Medicare Part D prescription drug plans cover at least two drugs per category to covering only one as a way to provide more flexibility and potential negotiation power, while at the same time expanding the ability to use utilization management tools.
“We worry this could create access issues for patients on high cost biologic medications,” the groups said in the letter. “We believe Part D benefits should not limit patients’ access to the medical therapy judged by the treating physician to be the most efficacious choice.”
“We worry that moving Part B drugs into Part D may lead to access issues and force patients into higher cost sites of care,” the groups said.
Third, the White House is proposing to cut Part B drug reimbursement to physicians from the current average sales price plus 6% down to ASP+3% for new drugs.
The groups said that with the budget sequestration currently in place, “the existing Part B payment structure does not adequately cover the costs of obtaining and providing these complex therapies in an outpatient setting. If additional payment cuts or negative changes are implemented or activated through demonstration projects, many patients would be forced into more expensive, less convenient settings to receive their therapies – if an alternative setting is available at all in their areas.”
Finally, the groups mention a proposal that would introduce physician reimbursement that is not tied to drug pricing. But this option is not expanded upon in the Council of Economic Advisors report.
“We request more clarity on any potential policies that would affect physician reimbursement,” the groups said. “Physicians have no control over the cost of drugs or ancillary services, nor over the severity of illness and comorbidities that drive the need for such services.”
The groups did support a few of the recommendations from the two documents, including requiring Medicare Part D plans to apply a substantial portion of the rebate at point of sale, establishing a Part D out-of-pocket maximum in the catastrophic phase to better protect beneficiaries against high drug costs, decreasing the consolidation by pharmacy benefit managers and others in the supply chain, and providing the Centers for Medicare & Medicaid Services with guidance on how drug-related value-based contracts and price reporting would affect other price regulations.
“We appreciate HHS’ continued focus on transparency and patient-centered care,” the groups said. “Knowing that HHS is committed to transforming the health care delivery system and the Medicare program by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improving outcomes, is reassuring to our providers.”