Washington Rheumatology Alliance

Earlier this year, Congressman Ami Bera, MD (D-CA-07) and Congressman Larry Bucshon, MD (R-IN-08) introduced legislation to provide relief for the large Medicare Physician Fee Schedule reimbursement cuts that are currently set to take effect on January 1, 2023.

This legislation, Supporting Medicare Providers Act of 2022 (H.R. 8800), would provide a one-year “hold harmless” payment to offset the looming reductions in the Fee Schedule. The bill also establishes a “Sense of the Congress” that the Department of Health and Human Services and the Congress should commit to:

1. ensuring financial stability and predictability in the Medicare physician payment system;
2. promoting and rewarding value-based care innovation; and
3. safeguarding timely access to high-quality care by advancing health equity and reducing disparities.

H.R. 8800 already has over 80 bipartisan cosponsors, but your support is needed to urge Congress to act on this bill.

Visit the CSRO Action Center to convey your support TODAY. With just a few keystrokes, you can send our template message to your representatives and make a lasting impact.

Thank you for getting involved!

Take Action Now

April 2022: Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care

With there being the potential concern of MAOs having the ability to increase profits by denying payments and access to services to providers, the OIG conducted this review from a random sample of 250 denials of prior authorization requests and 250 payment denials issued by 15 of the largest MAOs during the month of June 2019.

Report in Brief 

As an initial convening, Our Stories Rx is hosting a virtual roundtable conversation with Antonio Ciaccia, who served as the government affairs director for the Ohio Pharmacists Association in 2018, when a state audit revealed a PBM-led spread pricing scheme that overcharged the state Medicaid agency by over $200m.

Our Stories Rx invites you to a virtual roundtable with Antonio Ciaccia, President of 3 Axis Advisors and CEO of 46brooklyn Research, for a discussion on Pharmacy Benefit Managers and his experience unwinding the web of cost and access issues associated with PBM interactions between clinical providers, state Medicaid agencies, and patients across the US. The discussion will be moderated by Karen Ferguson, Practice Administrator at Arthritis Northwest, PLLC. This event will occur on Wednesday, 6/30, from 12p – 1p PST. Register by clicking here.

About Antonio Ciaccia:
Born and raised in pharmacy, Antonio has been involved with pharmacies his entire life.  After three years as a pharmacy technician and two years of pre-pharmacy curriculum, Antonio diverted course, graduating from The Ohio State University in 2007 with dual degrees in communications and political science before moving into the world of association management. Thinking that pharmacy would be in his rear-view mirror forever, he ended up making his way back to his pharmacy home, heading up government affairs for the Ohio Pharmacists Association.

After years of studying the pharmacy marketplace, Antonio became increasingly perplexed and concerned as he saw drug costs spiking while payouts to pharmacies were declining. Knowing something was being lost somewhere in the middle of an ever-growing transaction, Antonio has spent years working to crack the drug pricing code and pull the rug out from what he believes is one of the most dysfunctional marketplaces in the world.

About Karen Ferguson:
Karen Ferguson is the Practice Administrator at Arthritis Northwest, PLLC, the largest clinical rheumatology practice Northwest of Denver, and headquartered in Spokane, Washington. Karen founded Our Stories Rx, and is also the co-founder and CEO of Discus Analytics, Inc., a healthcare IT company addressing the unmet need for organized, discrete, and clinically actionable information supporting the physician and patient’s longitudinal journey together.

As Practice Administrator for Arthritis Northwest, Karen led her organization to earn the national recognition for quality care, “NCQA Patient-Centered Specialty Practice Recognition” which distinguishes practices that communicate, collaborate, and integrate care in ways that demonstrates constant improvement through communication, coordination, and providing access to care.

Ms. Ferguson is past President of the Washington State Medical Group Management Association and the Inland Empire Medical Group Managers Association. She currently serves as ARP/ACR Education Committee, NORM Payer Committee, and CSRO Payer Committee.  Ms. Ferguson received her Master of Science in Health Education/Promotion from Whitworth College, and a Bachelor of Science degree in Physical Education from San Diego State University.

About Our Stories Rx:
Our Stories Rx is a 501(c)4 organization focused on developing an interactive storytelling platform that will advocate for policy outcomes that improve the health and well-being of vulnerable patient populations and the community clinics that serve them. By documenting and publicizing the experiences of patients, clinical providers, and other purchasers of healthcare services, Our Stories Rx seeks to build qualitative and quantitative tools to advance a data-driven, community centered platform with a proactive vision for advocacy and policy reform.

On December 15, 2020, Genentech led a discussion about how the Most Favored Nations (MFN) model threatens provider and patient access to existing and future medicines; we share your concerns that this could have a detrimental impact on your practice and ability to treat patients. Genentech agrees that we have to work together across the healthcare delivery system to enable all Americans to receive appropriate and affordable care. As we do this, we must protect and sustain patient access to scientific innovation in the U.S. so that people with serious diseases continue to benefit from the breakthrough medicines they depend on. Never has this need been clearer than during the current COVID-19 pandemic.

Below is more information on the MFN model, Genentech’s position, as well as that of other organizations.

• HHS Press Release on MFN interim final rule
• Health Affairs Blog, “Administration Finalizes Most-Favored Nation Drug Pricing Rule At The Last Minute”
• Genentech statement on President Trump’s MFN Executive Order, and Genentech pricing philosophy
• Association statements: PhRMA, BIO, Community Oncology Alliance, American Hospital Association, American Cancer Society – Cancer Action Network

If you would like to independently advocate against this model, I suggest that you reach out to your physician specialty societies and ask them to:

• Engage policymakers, in Congress and in the current and incoming administrations, to stop the implementation of MFN;
• Communicate their concern to CMS via written comments; and
• Consider joining or pursuing litigation challenging implementation of MFN. The most expedient way to get societies involved in existing cases is for them to contact representatives at PhRMA (PHRMA_alliance@phrma.org) or BIO (info@bio.org).

Additionally, you can reach out to your federal and state representatives, to request that they weigh in opposing the model with their peers, and existing and incoming administration officials.

The Arthritis Foundation has free downloadable brochures and fact sheets through the AF Store​ that you can save to your office desktop. The brochures and fact sheets can be e-mailed to patients or you can print copies in-office and hand out to patients as needed. The downloadable materials are a convenient way to provide your patients, who may not be comfortable taking printed materials from your office as a result of the Covid-19 pandemic, the information they are looking for. Instructions are available here.

If you are in need of a bulk order of printed brochures or fact sheets, please contact your local Arthritis Foundation staff member at Washington@arthritis.org for assistance.

The Arthritis Foundation also created a Covid-19 Resources flyer that has a list of great patient resources to help them navigate the pandemic and stay connected.

WASHINGTON, D.C. — A new report from the IQVIA Institute for Human Data Science has determined that biosimilars are on track to reduce drug costs by $100 billion over the next five years if their use rises. The future of this lower-cost drug market, however, is still uncertain.

According to the report, three recently-launched biosimilars may reach 60 percent volume share by the end of their second year on the market, which would generate an estimated $80 billion in savings in the next five years, including $16-36 billion in 2024 alone. Click here to read the full article.

The Biosimilars Forum is a nonprofit organization incorporated in Washington, DC, created to advance biosimilars in the United States with the intent of expanding access and availability of biological medicines, and improving health care. The Biosimilars Forum provides evidence-based information to inform and support public policies that encourage awareness, access, and adoption of biosimilars.