The Digestive Health Physicians Association today announced its support of the Protecting Patient Access to Cancer and Complex Therapies Act (S. 2764, H.R. 5391) introduced by U.S. Senator John Barrasso (R-WY), U.S. Representative Mike Burgess (R-TX) and U.S. Representative Greg Murphy (R-NC).
A provision in the Inflation Reduction Act of 2022 cuts reimbursement for certain Part B drugs from Average Sales Price plus six percent to the Maximum Fair Price (MFP) that is negotiated by the Centers for Medicare & Medicaid Services (CMS). According to the Congressional Budget Office, reimbursement for Part B drugs (and the associated add-on payment) will be cut by an estimated 50 percent or more for those drugs that are subject to negotiation.
“An unintended consequence of the Inflation Reduction Act was that reimbursements to physicians were cut significantly, making it difficult to provide certain medications that our patients with chronic illnesses desperately need,” said Dr. Scott Ketover, president and board chair of DHPA. “This policy could jeopardize the viability of medical practices, especially smaller groups, and those in rural or underserved areas. If we are no longer able to afford to administer these drugs, our patients will be forced to get their medications in the more expensive hospital setting.”
The Protecting Patient Access to Cancer and Complex Therapies Act is budget neutral and would maintain current reimbursements to providers, while saving Medicare the same amount of money by replacing the ASP payment cut for Part B drugs with a manufacturer rebate. Patient’s coinsurance would be based off the lower, rebated price (the MFP) and the manufacturer rebate would account for the coinsurance reduction.
“The Protecting Patient Access to Cancer and Complex Therapies Act protects our ability to provide these complex therapies in our practices, while still achieving the same savings for the Medicare program,” said Dr. Ketover. “We hope Congress can advance this bill without delay.”
Rebates, such as the Medicaid Drug Rebate Program and inflation rebates in Medicare, are a common cost-savings tool used by the government and private payers and would not cause disruption to providers and beneficiaries.