Comment: Senate’s drug-price reforms would limit access

This piece was originally published by the Everett Herald here.

By Jeff Peterson / For The Herald

The patients I treat as a rheumatologist, most of whom are seniors or immune-compromised, face a great number of challenges navigating daily life.

The questions that many Americans have confronted since the onset of the covid pandemic about whether to engage in public spaces or what to do if an unexpected illness imposes economic insecurity, are questions that autoimmune disease patients face daily. For these individuals, access to medicine is a prerequisite for participating in activities that most people take for granted. Unfortunately, new restrictions soon to be imposed on medicines by the “reconciliation” bill currently being debated in the U.S. Senate would reduce the number of therapeutic options available to patients, and permanently shutter clinical practices in already under resourced Washington communities.

Previously known as the Build Back Better Act, the newly revived Senate compromise bill has been winnowed down over the last 15 months to a cynical shadow of its former self; dedicated to achieving federal deficit reduction at the expense of chronically ill patients and the community clinicians who serve them. Simply put, the legislation allows Medicare to lower reimbursement rates for medications that must be administered in a doctor’s office to treat diseases such as arthritis and cancer. Many community clinics are already on the brink of insolvency, and if this legislation passes, some will simply close after going underwater, or stop carrying medicines that cost more to administer than the clinic would receive in renumeration from the federal government.

Medicare will spend less money on providing treatments for Americans this way, but in exchange for major access problems for patients living in rural areas, or for individuals lacking transportation options. As fewer and fewer clinical sites offer the treatments that patients need, many will be forced to travel hours away from work or home to find infusion medication for their complex chronic illnesses.

If senators were serious about using this opportunity to improve therapeutic access, they wouldn’t undermine clinical care networks reliant on Medicare’s existing “buy-and-bill” fee structures and methodology. When Congress wants to explore different, or value-based, reimbursement models, they should partner with physicians in a way that preserves networks of care around vulnerable patient populations while legislative adjustments are being made.

Instead, Senate negotiators removed traditional pathways for patients and clinicians to even provide feedback on how these downward adjustments would impact local communities. Bad politics often follows bad policymaking, but rarely in a high-stakes election year when pocketbook concerns are top of mind for most working families. It seems clear that lawmakers aren’t interested in listening, so we must find other ways to make our voices heard.

To make matters worse, every credible analysis of the Senate bill, including the most recent one performed by the independent Congressional Budget Office, indicates that the policies now being rushed through the Senate will stifle new therapeutic discovery and lead to fewer cures coming to market in the coming years.

It’s unconscionable that elected officials would hamstring our domestic life science innovation ecosystem as we continue to grapple with ever-evolving variants of covid-19. It took 30 years of research to develop the mRNA technology that undergirds our contemporary vaccine delivery platforms; work that started long before anyone had an inkling of the toll the pandemic would take on humanity.

Today, Americans have access to 90 percent of new treatments and cures. In countries that employ cost-cutting tactics similar to what the Senate is contemplating, patients have access to fewer new medicines and wait longer to get them. For patients with terminal illness, and for those still waiting for a cure, therapeutic access is a life-or-death proposition.

Washington patients deserve better than a rushed reconciliation bill that fails to account for important nuances in our health care delivery system. Instead of undermining community physician practices and taking away medicines from patients to achieve budget deficit reduction goals, Congress should go back to the drawing board to craft legislation that will lower out-of-pocket costs for patients and promote innovative approaches to the next frontier of new medical discovery.

Dr. Jeff Peterson is the president of the Washington Rheumatology Alliance.