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Patient and provider groups ask CMS: Don’t turn back the clock on rheumatic disease care

April 21, 2016
Writing today in The Hill, Ann Palmer of the Arthritis Foundation and Joan Von Feldt of the American College of Rheumatology have a message for CMS: don’t turn back the clock on rheumatic disease care by proceeding with the recently proposed payment cuts in the Medicare Part B program.

They write:
The Centers for Medicare & Medicaid Services (CMS) recently proposed additional Medicare Part B payment cuts that would make it exceedingly more difficult for rheumatologists to obtain and administer biologics. The move would unquestionably exacerbate existing patient access problems, leaving many arthritis patients without treatment options, and pushing others toward more expensive settings like hospitals for their care.  Hospital-based infusions often come with higher copays, longer travel times, and the distinct disadvantage of patients having to receive complex therapies absent of the supervision of their trusted rheumatologists, who know the unique personal history of their complicated condition and can monitor for adverse reactions.

For these reasons, arthritis patients and providers are coming together to ask that the proposal to alter Medicare Part B coverage be withdrawn so that patients and providers can have input and so that the potential negative impacts on patients can be understood and avoided.

CMS’ proposed reimbursement changes are part of an experiment the agency says will support  the delivery of high-quality care by incentivizing doctors to prescribe the most cost-effective drugs. There’s just one problem: the approach assumes there are less expensive yet equally effective therapy alternatives for all diseases.  For patients with rheumatic diseases like RA, this simply is not the case.  Biologic treatment options available under Part B are relatively limited, typically with similar pricing.

Read the full piece here.