ACR Appreciates Telehealth Coverage Extension, Disappointed Congress Fails to Reform PBMs, Mitigate Medicare Cuts

ATLANTA - The American College of Rheumatology (ACR) today commended the limited extension of key Medicare telehealth coverage provisions but also expressed disappointment that Members of Congress have failed to pass measures to bring transparency to pharmacy benefit manager (PBM) practices, address flawed insurer practices or mitigate the Medicare Physician Fee Schedule (MPFS) rate cuts scheduled to take effect on January 1.

“It’s disappointing that Congress has once again allowed payment cuts that threaten the durability of the Medicare physician payment system,” said Carol Langford, MD, MHS, president of the ACR. “America’s doctors and their patients deserve stability that includes meaningful reform to ensure continuity of care for our nation’s growing Medicare population.”

In November, the Centers for Medicare & Medicaid Services (CMS) issued its final Medicare Physician Fee Schedule rule that included a 2.83% cut to next year’s conversion factor to physician payment. This amounted to a cumulative cut of 29% to physicians over two decades while operating costs have risen 39% when adjusted for inflation. The ACR has long advocated for legislative solutions that not only address these payment cuts but also work to reduce administrative burden, adjust payment rates to address inflation and create longer-term payment stability.

The legislation did include a limited extension of important pandemic-era telehealth provisions until March of next year. These provisions have helped to expand care to areas where the availability of rheumatologists may be severely limited and allowed individuals facing mobility or transportation issues easier access to care. 

“Over 58.5 million Americans live with rheumatic disease, and for many of these individuals, it can be difficult to access care due to mobility restraints, limited regional availability of rheumatologists, or cost constraints that make care unaffordable,” Dr. Langford continued. “Extending telehealth coverage will ensure continued access to care for mobility-challenged or rural patients.”

ACR is also discouraged that PBM reforms included in the initial funding proposal were also stripped from the final package. It briefly looked like Congress would consider implementing greater oversight of PBMs, including reforms to ensure 100% of rebate savings are passed through to patients, “delinking” PBM income from negotiated drug prices, increased oversight requirements and studies to bring more transparency to PBM business practices, and Medicaid restrictions on spread pricing.

Finally, ACR-supported legislation, the Improving Seniors Timely Access to Care Act of 2024 (S. 4532/H.R. 8702) and the Safe Step Act (S. 652/H.R. 2630) has also failed to pass this Congress. These bipartisan measures, respectively, would have addressed prior authorization and step therapy policies that often lead to delayed treatment and increased administrative burden for physicians.

“In the next Congress, ACR will continue to advocate for priorities that expand patient access to care and protect the doctor-patient decision-making process. This includes addressing prior authorization and step therapy policies that delay or deny access to care,” Dr. Langford concluded. “Finally, the lack of an inflationary adjustment measure and budget-neutral constraints will remain an ongoing issue in the Medicare Physician Fee Schedule until Congress takes action to address them for the long-term. That said, I remain hopeful policymakers will work with us in the coming year to address these important health policy issues.”

Media Contact
Monica McDonald
mmcdonald@rheumatology.org

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The American College of Rheumatology (ACR) is an international medical society representing nearly 10,000 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy, and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management, and treatment of more than 100 different types of arthritis and rheumatic diseases.