Press Releases

ACR Responds to the 2019 Benefit and Payment Parameters Proposed Rule

Statement from Sharad Lakhanpal, MBBS, MD, President of the American College of Rheumatology regarding the 2019 Benefit and Payment Parameters Proposed Rule

The American College of Rheumatology (ACR) has been a consistent advocate for policies that improve the patient’s experience in the health care system and provide affordable and accessible healthcare coverage to the 54 million Americans living with rheumatic diseases. We are pleased to see that the Centers for Medicare and Medicaid Services (CMS) is working to reduce fiscal and regulatory burdens to obtaining coverage and we applaud the agency for considering proposals to help reduce drug costs and promote price transparency.

However, regarding state essential health benefit (EHB) flexibilities, we have several concerns about how states will be able to ensure that people living with rheumatic diseases can continue to receive the care they need. Specifically, we believe that any regulatory changes to the federal healthcare exchanges should:

  • Allow for greater transparency of plan options so patients have a clear understanding of benefits, provider networks, drug formularies, and out-of-pocket costs.
  • Expand access to rheumatology care to help patients manage their conditions and avoid disability.
  • Protect patient access to prescription drugs by prohibiting drug formularies that are overly restrictive and/or have excessive cost sharing. Prescription drug spending should also be prohibited from being subjected to plan deductibles.

In the coming weeks, the ACR will be reviewing the rule in-depth and will be submitting detailed comments to CMS. In the meantime, we look forward to engaging with the agency as it develops innovative coverage models and transparency guidelines that expand patient access to care.

Jocelyn Givens
703-548-0019
404-633-3777, ext. 810

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The American College of Rheumatology (ACR) is the nation’s leading advocacy organization for the rheumatology care community, representing more than 9,500 rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.

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