NICA: Patients Deserve a Better Plan to Afford Drug Costs

Patients in infusion centers across America have one thing on their minds — getting better. Many of these individuals are there receiving treatment for serious chronic illnesses like Crohn’s disease, rheumatoid arthritis, multiple sclerosis, psoriasis, psoriatic arthritis, lupus, etc.

The last thing they want to face is a tangled mess of bureaucratic red tape standing between them and the care they need. Unfortunately, that is exactly what the Trump administration is looking to institute within a critical portion of Medicare.

The proposed changes to the program would utilize a mandatory International Pricing Index “model,” or coverage experiment, to change how U.S. drugs are priced, how they are acquired, and how they are reimbursed for half of the nation’s providers administering medications covered by Medicare Part B. This model would arbitrarily restructure reimbursements for providers while placing additional administrative obstacles in the treatment pipeline that patients will have to contend with. Additionally, this model would attempt to fix an aspect of Medicare Part B that has been working well — timely distribution of medications — by bringing new distributors into the supply chain.

Patients and providers could experience delays while waiting for these distributors to develop nationwide distribution strategies and infrastructure. Because a majority of Part B medications treat some of the most complex and serious illnesses, the impact of these reforms will disproportionately fall on our most vulnerable patient populations — many of whom receive care at infusion centers.

For many physician practices, the compulsory nature of the proposed International Pricing Index model may jeopardize their ability to care for patients. Reshaped delivery channels and regressive new reimbursement policies, as laid out by the plan, may make treating Medicare patients unsustainable for many neighborhood practices. Ultimately, the resulting vertical integration or closures of office-based infusion facilities would funnel even more patients into hospital care settings, further reducing the affordability of care for patients while raising the overall cost of care in our system.

For the facilities that are able to maintain their practices, patients’ access to effective, tailored care may be restricted, delayed or disrupted. By structuring America’s medication market like that of other countries that restrict access to medicines, the Trump administration is, in essence, making treatment decisions that were once left to patients and their doctors. Existing therapies covered under Medicare Part B may become inaccessible under the plan.

As once-promising treatment regimens fall by the wayside, patients’ motivation to adhere to prescribed care plans may diminish, resulting in higher medical costs in the future for once-controlled chronic illnesses. Even if patients and their doctors are able to appeal, the proposed model creates a complicated web of middlemen and bureaucratic barriers that will likely cause delays for those in need of immediate intervention.

Lowering out-of-pocket costs for patients requiring medications under Medicare Part B should be a priority, but we must ensure that reform measures do not disrupt patients’ access to care. There are other policy options to address the concerns of patients with high out-of-pocket costs that take into account the realities on the ground.

By aggressively moving forward with this drastic plan to fundamentally alter the care of millions of Medicare beneficiaries, the Trump administration and Centers for Medicare and Medicaid Services risk exacerbating existing problems, while creating new ones in the process. We can address our nation’s rapidly accelerating consolidation of health care facilities, while providing quality, timely care to our seniors who need it.

We can do these things while reducing out-of-pocket costs and ensuring each patient receives the individualized care he or she deserves by supporting the sustainability of low-cost care models. The proposed International Pricing Index model falls short because it puts splashy headlines over the health and well-being of patients looking for one thing — to minimize the physical, emotional and economic burdens of disease.

This op-ed was posted in Morning Consult.

Brian Nyquist is the executive director of NICA, where he oversees headquarter operations and works to build relationships with providers, industry members and other advocacy organizations in order to collaboratively educate stakeholders and increase patient access.

August 26, 2019