The American College of Rheumatology (ACR) issued a letter of concern in response to the Medicare Payment Advisory Commission’s (MedPAC) new recommendation to further cut physician reimbursement for infusing life-altering treatments as part of its June 2023 Report to the Congress: Medicare and the Health Care Delivery System. In the letter, the ACR rejected MedPAC’s allegation that physicians prescribe and administer the highest-priced medications so that they can receive higher reimbursements. MedPAC suggested that Congress maintain an add-on payment amounting to 6% of the average sales price for the lowest-cost drugs, reduce the add-on payment for mid- to high-cost drugs, and implement a payment cap for the costliest drugs. The ACR argued that the 6% add-on payment does not incentivize the prescription of high-cost treatments, but instead is meant to offset the costs of acquiring, storing, and administering treatments—especially since physicians must buy the drugs in bulk, keep a full-time staff to administer therapy, and only bill Medicare after patients receive treatment. The ACR warned that MedPAC’s recommendation would force physicians to cut back on offering certain therapies or medications at a loss, limiting patients’ access to required therapies, and threatening practice viability.
June 23, 2023