Angus Worthing, MD, Says ACR Will Continue to Push HHS On Part B Reimbursement

Samantha DiGrande

In an interview with The Center for Biosimilars®, Angus Worthing, MD, FACP, FACR, chair of the American College of Rheumatology (ACR) Government Affairs Committee, explained the next steps for ACR after submitting a comment letter to HHS on reimbursement for Part B drug costs and prior authorizations.

Last month, the American College of Rheumatology (ACR) submitted a letter to HHS applauding CMS’ decision to assign unique J-codes to biosimilars and calling on CMS to address policies regarding prior authorizations. The letter also urged leaders to reverse a decision to adjust providers’ reimbursement for Part B drug costs based on physician performance under the Merit-Based Incentive Payment System (MIPS).

When asked if he thinks CMS will be responsive to the suggestions provided in the letter, Angus Worthing, MD, FACP, FACR, chair of ACRs Government Affairs Committee, told The Center for Biosimilars® in an email that ACR plans to meet with new HHS staff in the upcoming months in order to work collaboratively to address any barriers that may limit the ability of patients with arthritis or other rheumatic diseases to obtain care.

“The agencies have put out many requests for information lately,” said Worthing. “We take this as a positive, because we have the opportunity to voice our concerns, suggestions and praise, ultimately aiding in making our members’ voices heard.”

Overall, Worthing says, CMS had been responsive on all issues addressed in ACR’s letter. He feels that, as far as biosimilars are concerned, the government has listened to ACR’s suggestions, and he believes that it will continue to track this issue and support the continued implementation of policies to encourage biosimilar use.

In regard to adjusting providers’ reimbursement for Part B drug costs—based MIPS performance, Worthing felt that HHS had been receptive to suggestions: “They cite being bound by statue to interpret the law as they have. I believe they are listening and willing to work with Congress [and] physicians on this. From our Hill meetings with committee staff, we know that they have been talking to CMS about this issue to find the best solution possible, and we are hopeful this issue will be fixed in the Medicare Extenders package.”

Worthing said that ACR has already met with CMS' principal deputy administrator, Demetrios Kouzoukas, to discuss the current prior authorization process, which ACR says wastes time and resources, with a follow up meeting scheduled for February 5. “CMS staff have been engaged and interested in learning more about these issues from providers and patients. It appears the rule-making process or issued guidance are very palatable to CMS at this time. ACR and allied groups are working hard with CMS on these issues and will continue to do so,” said Worthing.

The next step for ACR is to continue to raise awareness of its cause: “With Part B, if this issue is not fixed, ACR will continue to meet with Hill staff and CMS to advocate for changing this policy. On all these topics, ACR will continue to submit comments to regulatory agencies when applicable and meet with the agencies relevant staff…we will continue to educate state legislators and support state legislation that aligns with our priorities,” said Worthing.