Integrated Practices | Comprehensive Care

April 2024   

In this issue we feature: 

March Fly-In Recap

In March, LUGPA hosted its first DC Fly-In of 2024, advocating for crucial healthcare reforms:

  1. Sustainable Physician Reimbursement and MACRA Reform: Promoted rational reform tying Medicare reimbursement to practice costs and fundamental MACRA changes.
  2. Seniors Access to Critical Medications Act (HR 5526/S. 3458): Endorsed legislation to protect and restore enhanced access to critical Part D drugs to patients' homes in tandem with in-office dispensing programs.
  3. Protecting Patient Access to Cancer and Complex Therapies Act (HR 5391/S. 2764): This bill emphasizes preserving physician reimbursement for the delivery of Part B drugs.

Discussions centered on Physician Fee Schedule reform to ensure the continuity of care for all patients both rural and urban), pharmacy benefit manager (PBM) reforms, and workforce development, including the need for Graduate Medical Education (GME) reform, with lawmakers showing interest and support on both sides of the aisle.

The complete recap can be found here


In-Office Dispensing Reform Bill Advances: LUGPA's Advocacy Efforts Yield Progress

In March, the Energy & Commerce Committee marked up H.R. 5526, the Seniors’ Access to Critical Medications Act of 2023 (sponsored by Reps. Harshbarger, Wasserman Schultz, and Davis). This bill, a priority for LUGPA, will enable our practices to once again deliver Part D medications to patients' homes. After concerted bipartisan efforts to build support, LUGPA is pleased with the bill's advancement. We are actively engaging with Members to garner their support and discussed this legislative initiative at our recent March DC fly-in.


LUGPA Advocates for 340B Program Reform in the Senate  

In March, LUGPA drafted and disseminated a letter to Senate healthcare leaders, urging their support for much-needed reforms to the 340B Program. Despite the original intent of the 340B drug program, to aid uninsured and indigent patients, mounting demonstrates misuse and subversion of the program, both in the patients to whom care is delivered and as an unintended catalyst to hospital and system acquisition of independent physician practices. Congress is actively soliciting feedback for necessary reform of the program to address these deficiencies, including clarifying patient eligibility criteria, addressing ‘child sites,’ and undertaking CMS’ previous recommendation for a survey of hospital drug acquisition costs under the program.

LUGPA staunchly advocates for establishing a solid definition for legitimate 340B patients and reforming child sites to realign with the program's objectives. Furthermore, we wholeheartedly endorse bipartisan initiatives like H.R. 3237, which seek to enhance transparency and accountability within the program.

The full letter can be found here.


Coalition Formation for Biomarker Testing Access

In March, LUGPA joined a new coalition with national healthcare advocacy groups to advocate for comprehensive coverage of biomarker testing, which is essential for precision medicine. Through legislative initiatives led by the American Cancer Society Cancer Action Network, the coalition aims to ensure equitable access to biomarker testing by insurers, including Medicaid programs. Model legislation outlines coverage requirements based on robust medical evidence, emphasizing timely approval processes and parity in coverage across risk-bearing entities. 


Advocating Against Insurance-Mandated Step Therapy  

LUGPA supports the Safe Step Act, which addresses barriers to timely access to medications caused by insurance-mandated step therapy. LUGPA prioritizes patient well-being and access to appropriate treatments by advocating for a reasonable exception process. LUGPA recently signed a letter to Congress advocating for pharmacy benefit manager (PBM) reform in response to the potential inclusion of such reforms in the upcoming appropriations package. 

The full letter can be found here.

divider LUGPA’s Advocacy Efforts Yield Results   

In March, LUGPA, alongside other medical organizations, successfully influenced Congress to mitigate half of the 3.4% payment cut to the Medicare Physician Fee Schedule (MPFS) conversion factor through the Consolidated Appropriations Act. This victory reflects ongoing advocacy efforts, including congressional engagement, letter campaigns, and stakeholder collaboration. LUGPA remains committed to advocating for longer-term physician payment reform and will inform members of developments. While not a complete rollback of the cuts, this mitigation will bring substantial relief to our members, and we will continue to push for further reform. 

divider CMS Responds to Cyber-Attack Impact on Healthcare Providers

Following the cyber-attack on CHANGE Healthcare, LUGPA has been monitoring its impact on medical claims and payments. CMS has issued additional assistance, particularly for Part B providers, considering accelerated and advanced payment applications. LUGPA remains vigilant in safeguarding healthcare data and ensuring seamless operation of healthcare systems amidst cybersecurity challenges.

For additional information and resources on cybersecurity in healthcare, please visit LUGPA's dedicated page: Improving Cybersecurity for Healthcare Providers.

For further details, please refer to the following resources:

divider White House Releases New Fact Sheet on Prescription Drug Costs

The White House is actively pursuing healthcare reform to ensure access and affordability for all Americans. Through legislative measures like the American Rescue Plan Act and the Inflation Reduction Act, they aim to lower prescription drug costs and health insurance premiums. Notable achievements include capping out-of-pocket expenses for prescription drugs, particularly insulin, benefiting seniors and individuals with disabilities.

Efforts to enable Medicare to negotiate drug prices demonstrate a commitment to challenging pharmaceutical companies and reducing healthcare expenses. The administration prioritizes expanding access to mental health care and preventing surprise medical bills, showing dedication to consumer protection. Proposals to close the Medicaid coverage gap and improve nursing home staffing reflect a comprehensive approach to strengthening healthcare nationwide. President Biden's budget initiatives emphasize securing Medicare funding and protecting seniors' health and dignity while also aiming to expand access to quality healthcare services for all Americans.

The White House Fact Sheet is available here.

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