Medicare Part B Drug Payment Proposed Rule

The Center for Medicare and Medicaid Services (CMS) has released a new proposed regulation called “Medicare Part B Drug Payment Model.” This proposed rule has been getting quite a bit of press lately, so you may already be aware of it.

This letter is to inform you of the impact this change in Medicare’s reimbursement policy will have on your care here at Rheumatic Disease Associates Ltd. and what action you can take that may prevent it. The issue in question is the reimbursement for all in-office infusible and injectable medications (for example, Remicade, Rituxan, Orencia, Actemra, Benlysta, Prolia, Simponi Aria, Cimzia, and others). As you are aware, these are innovative, vital medications that can dramatically improve a patient’s quality of life and reduce the chances of disability and even death.

The new proposal by the Center for Medicare and Medicaid Services (CMS) may make it financially impossible for physicians to provide such medications in the office. The reimbursement to our office would be cut so drastically that our Infusion Room would be unavailable to Medicare patients, and might eventually be closed altogether. In the worst case scenario, you would be forced to seek infusion treatment in a hospital setting which changes the continuity and the one-on-one care you are currently receiving. In the end, this proposal does not really save any money, since hospital-based infusions costs Medicare up to 3-times as much as private infusion centers.

What can you do about this? First, contact Medicare whether you currently have Medicare or not. They need to hear how this will affect your access to care, the difficulty of shifting your treatment from the office to hospital setting and how it will impact the quality of your care at the infusion room. The address, telephone number and internet link are listed below.

Medicare is accepting comments about these changes up to May 9th, so please contact them soon!

or by regular mail to: Centers for Medicare & Medicaid Services

Department of Health and Human Services

Attention: CMS-1670-P

P.O. Box 8016

Baltimore, MD 21244-8016

Also, contact our own Pennsylvania Senator Pat Toomey, who is the Chairman of the Senate Subcommittee on Health Care, and he is running for re‐election. He will understand your plight and can act to influence Medicare. Tell him that instituting the Medicare Part B drug payment model will not achieve CMS’s goal of high quality care at lower costs. It will only jeopardize access to the medications needed to keep patients healthy. It is best that he hears from you in your own words that a change of this magnitude will make it more difficult to get the medication that you desperately need to maintain your health.

Contact Senator Toomey at:

248 Russell Senate Office Building Phone: (202) 224-4254

Washington, DC 20510 Fax: (202) 228-0284

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