Drug pricing and patient access to medically necessary drugs were the focus this week during the Academy’s virtual Ophthalmic Leadership Advocacy Group meeting.
The Academy continued its education of policymakers on the limitations on Avastin access, as well as the need for higher Medicare reimbursement. In addition, the groups endorsed the Academy’s efforts to bring about reinstatement of the previous ban on step therapy in Medicare Advantage plans.
Academy leaders and our subspecialty partners from across the country expressed support for another strong push for drug reforms as Congress considers cost-saving strategies. Shawn Bishop, chief health adviser of the Senate Committee on Finance, joined the discussion Monday night and offered insights on some of the policies Congress is considering. She indicated that they are also exploring the possibility of bipartisan legislation.
The advocacy group meetings are one of the few opportunities subspecialty society and specialized interest group leaders in the ophthalmic community have to gather and collaborate on policy development.
Congressional Insights on Drug Pricing Legislation
Participants had an opportunity to interact with Bishop, who helped develop the bipartisan Prescription Pricing Reform Act of 2019, while serving as senior adviser to then-Finance Committee ranking member Sen. Ron L. Wyden, D-Ore. The Finance Committee is using the 2019 legislation as a starting point for drug pricing legislation currently being developed.
Next Steps in Congress for Drug Reforms
Drug pricing reform was not included in the infrastructure proposal, the American Families Plan, that the Biden administration released in April. However, House and Senate committees have held hearings to discuss potential actions on the issue.
Although federal legislators may be poised for action with the recent introduction of competing legislative proposals on drug pricing in the House of Representatives, the question still remains: How will Congress advance the drug reform issue this year?
Michael X. Repka, MD, MBA, the Academy's medical director for governmental affairs, questioned if congressional leaders had decided how Congress might consider drug pricing reform legislation this year. With small margins in both the House and Senate, finding a path forward could prove challenging for Democratic congressional leaders.
Bishop indicated that they are focused on developing the drug pricing policies while they explore whether there will be an opportunity for bipartisan legislation or if Democrats will look to pass reforms using a budget legislative vehicle that only requires a majority vote in the Senate.
However, a challenge Congressional leaders face is that Democrats and Republicans are on different spectrums when it comes to health care reform, leaving little room for bipartisan negotiations.
Push to Preserve Patient Access to Treatment
Academy leaders informed Bishop that Avastin usage has been declining over recent years while use of higher cost drugs has been increasing largely due to low reimbursement and a fragile supply chain. Now, because of the current Avastin shortages, ophthalmology practices are experiencing greater challenges with acquiring the repackaged drug for its patients. We urged the Centers for Medicare & Medicaid Services in a letter today to press the Medicare administrative contractors to make the needed adjustments to Avastin reimbursement for the current supply.
Ophthalmologists also shared their perspectives on prior authorization and Medicare Advantage plans with step therapy requirements, which are barriers to timely patient health care.
“The Medicare population has a high incidence of minorities,” said George A. Williams, MD, Academy senior secretary for advocacy. “There is significant evidence that step therapy leads to inequities in health care delivery.”
After receiving our letter (PDF) in April, the Biden administration has agreed to meet with us to discuss our documented step therapy patient stories.
“Perhaps, the new administration will look at drug reforms through the lens of health care inequity, and we’ll get more traction,” Dr. Williams said.
If you have examples of how Medicare Advantage step therapy requirements for Part B drugs have impacted patients to share, send them to email@example.com.
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