Press Releases

ACR Responds to Medicare Part D and Medicare Advantage Proposed Rules

Statement from Dr. David Daikh, MD, PhD, President of the American College of Rheumatology

Upon initial review of the Medicare Part D and Medicare Advantage proposed rules, the American College of Rheumatology is pleased to see the inclusion of several proposals that would improve care access and affordability for Medicare patients living with rheumatic diseases.

Specifically, we applaud CMS for exploring mechanisms to lower drug costs through greater pricing transparency on the part of pharmacy benefit managers. We are also encouraged that CMS is taking steps to update guidance regarding discriminatory cost-sharing practices.

Further, we applaud CMS for proposing to revise the definition of generic drugs to include follow-on biological products, solely for purposes of cost-sharing. Lower cost alternatives can improve enrollee incentives to choose follow-on biological products over more expensive reference biological products, and can reduce costs to both Part D and Medicare Advantage.

However, we have concerns regarding the enrollee notification process for when a mid-year formulary change occurs. We believe enrollees should have ample notification on any medication switches.

In the coming weeks, the ACR will be taking an in-depth look at these proposed rules and will be submitting detailed comments to CMS. In the meantime, we look forward to engaging with the agency as it develops further guidance for the MA and Part D programs.

Jocelyn Givens
jgivens@rheumatology.org
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.