Physician Groups Argue Combining Medicare Formularies Would Hurt Patients

A group of physician associations recently sent a letter to the HHS claiming that new drug pricing proposals for Medicare will harm patient access and health care outcomes.

The letter was signed by nine physician groups, including: the American Academies of Dermatology, Neurology, Ophthalmology, Physician Medicine and Rehabilitation; Colleges of Gastroenterology and Rheumatology; associations of Gastroenterological and Urological; and the Infectious Disease Society of America.

“Early and appropriate treatment by a specialist can control disease activity and prevent or slow disease progression, improve patient outcomes, and reduce the need for costly downstream procedures and care compared to care provided solely by primary care providers,” they wrote. “Drug pricing policy is key to access and outcomes for our patients, which is why we reach out to you today.”

They expressed concern with a number of drug pricing proposals, including the plan to increase Medicare Part D formulary flexibility. They noted that this policy would change the minimum required treatment options per category from two to one. Currently, Medicare Part D formularies include almost all cancer drugs.

According to the letter, this could limit patients being treated with high-cost biologics and prevent physicians from prescribing the drugs that they felt would provide the best long-term outcomes.

“We reiterate that allowing the most appropriate and efficacious therapy as judged by the treating physician can also result in long-term cost savings,” they wrote.

Furthermore, they claimed that the recent proposal to consolidate the Medicare Part B formularies with Medicare Part D formularies. They argued that this plan would result in access issues for patients and force them into higher cost care settings—due to high out of pocket costs.

“Formulary structure and cost sharing is different between Part B and Part D, and we are concerned that out of pocket costs for patients would be very high, especially with the biologics prescribed by rheumatology, oncology, and neurology,” they wrote. “Further, Part D has no supplemental coverage to help with out of pocket costs.”

They noted that these proposals run counter to the goal of reducing overall health care costs and improving patient care.

“Our organizations are dedicated to ensuring that physicians have the resources they need to provide patients with high-quality care,” they concluded. “We believe HHS should make policy proposals designed to reflect the needs of complex care patients, reduce administrative burdens, and increase access to care.”

—David Costill

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