Nine Physician Groups Oppose Proposed Drug Pricing Changes

Nine physician groups sent a letter to HHS Secretary Alex Azar Wednesday expressing concern about drug pricing proposals related to Medicare Part B and Medicare Part D that they said would hurt patient care.

The letter said a plan to consolidate certain physician-administered drugs covered under Medicare Part B into the Part D program would create patient access issues. The plan would also cut physician reimbursements for new drugs below the current payment rates.

The changes would force patients to seek treatment in higher-cost sites of care, the letter said, and because Medicare Part D does not allow for supplemental coverage, patients would be responsible for larger portions of the cost of their biologic therapies. Medicare Part D plans have relatively high cost-sharing for specialty drugs.

Medicare Part B and D have differing formulary structures and cost sharing, and consolidating them would increase patient out-of-pocket (OOP) costs for patients, especially for those who take biologics.

The administration plan­—included in last month’s Bipartisan Budget Act of 2018–would also change Medicare Part D formulary standards to require a minimum of only 1 drug per class rather than the current 2. That could limit patient’s access to the medical therapies chosen as the most effective by their physician, the doctors’ groups said.

The letter was signed by the American College of Rheumatology, American Academy of Neurology, American Academy of Ophthalmology, American Urological Association, American Academy of Dermatology Association, American Academy of Physical Medicine and Rehabilitation, American College of Gastroenterology,

American Gastroenterological Association, and the Infectious Diseases Society of America.

The group also opposes a proposal to cut physician reimbursements for in-office treatment from the current average sales price (ASP) plus 6% to ASP plus 3%.

“Many small and rural practices lack the ability to negotiate bulk discounts in their drug purchases and have already been forced to stop administering biologic therapies to Medicare patients,” the letter read.

The physician groups said that they are supportive of policies that would lower drug prices while increasing access to vital medications, including:

• Requiring Medicare Part D plans to apply a substantial portion of rebates at the point of sale
• Establishing a beneficiary out-of-pocket maximum in the Medicare Part D catastrophic phase, providing beneficiaries with better protection against high drug costs
• Decreasing the concentration in the pharmacy benefit manager (PBM) market and other segments of the supply chain
• Providing guidance from CMS on how drug-related value-based contracts and price reporting would affect other price regulations

In January, the American Society of Clinical Oncology (ASCO) expressed similar concerns to CMS, looking to guard patients with cancer from high OOP costs that will impede patient access to cancer drugs under proposed changes to Part D.

Medicare Part D plans are currently required to include nearly all cancer drugs in their formularies.