As a local rheumatologist who treats Medicare patients, I am deeply concerned by a recent proposal from the federal Centers for Medicare & Medicaid Services (CMS) that could result in further payment cuts for Medicare Part B drugs. If implemented, this mandatory payment model test would wreak havoc on patients and cause massive access and safety problems.
Many rheumatologists have already been forced to stop administering biologic therapies to Medicare patients suffering from arthritis, lupus, and other rheumatic diseases because the current Part B payment structure does not cover the cost of obtaining and providing these complex therapies to patients. An additional payment cut would drive even more Medicare patients into less safe and more expensive settings - such as the patient's home or the hospital - to receive needed therapies, if they can access them at all.
The proposed pay cuts are intended to incentivize physicians to prescribe less expensive drugs, but there are very few Part B biologics available to rheumatology patients to begin with, and their costs are all similar. Biologics are complex and cannot be easily interchanged or switched for less expensive options. Once a patient finds a biologic that works for him or her, it may be the only option.
Rheumatologists welcome meaningful reforms that will make biologics more affordable. However, the current proposed Medicare payment cuts will do nothing more than restrict Medicare patients' access to safe and life-changing therapies.
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The writer lives in Loris.