Proposed Changes to Medicare Part B Could Limit Access To Infusion Treatments

Medicare is a federal health insurance program that pays for a variety of health care expenses. Beneficiaries of this program are generally senior citizens aged 65 or older, but younger adults with permanent disabilities may also be eligible in some cases. I don’t have any personal experience with Medicare – and seeing as I’m only 33 it will likely be quite some time until I do. But I do know that many people living with rheumatoid arthritis depend on Medicare to provide the treatment they need, which is why I have concerns about the proposed changes to Medicare Part B.

Medicare Part B is medical insurance that covers certain non-hospital medical expenses, like doctors’ office visits, blood tests, X-rays, diabetic screenings and supplies, and outpatient hospital care. The Centers for Medicare & Medicare Services (CMS) is currently considering a proposed Part B Drug Payment Model. Organizations that support patients, like the Arthritis Foundation, as well as physicians groups, like the American College of Rheumatology, are concerned about how these proposed changes may impact patients living with rheumatoid arthritis.

For starters, both organizations are concerned about the lack of stakeholder engagement in the proposal design process. This means that CMS designed the Part B Drug Payment Model without any input from the patients and providers who will be impacted by the policy. Without stakeholder engagement, policy-makers may not have a clear understanding of the unique needs of the patient populations that may be affected. For example, arthritis treatment is extremely nuanced, and a treatment that may be the most clinically effective on paper may not work for a particular patient. This means that a one-size-fits-all policy will not be effective for patients living with arthritis.

There is also concern about how the proposal might impact patient access to necessary medications and non-hospital infusion sites. If the proposed changes go into effect, there are many health care providers, such as small group and solo practitioners, who may not be able to continue offering infusions in their offices. Patients who can no longer receive infusions in their doctor’s offices will be forced to get their infusions in a hospital setting, which will drive up their out-of-pocket expenses. And, for patients in more rural areas, this would create an additional financial burden on them to travel long distances for their care. This burden is magnified even more by the fact that people with chronic diseases like rheumatoid arthritis need to receive infusions on a regular basis. If a patient cannot handle this increased financial burden, they may lose access to their infused medication – even if they were stable on that medication and even if they were not responsive to alternative medications.

The proposed Part B Drug Payment Model is also a value-based model, and it contains very little discussion of patients and patient choice. This is a problem, because ultimately any proposal that seeks to maximize health care quality must be patient-centered. Instead, this proposal could lead to patients losing access to infusions they depend on to function in daily life, even if it has taken that patient years to find a medication that works. I am very grateful that the Arthritis Foundation and the American College of Rheumatology have taken the time to send detailed letters to CMS outlining their concerns about the proposed Part B Drug Payment Model. (If you’d like to read the letters you can find the Arthritis Foundation’s letter here and the American College of Rheumatology’s letter here). For the benefit of Medicare patients living with rheumatoid arthritis, I truly hope CMS will take these concerns into consideration before making their decision.

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