Posted: January 29, 2020
Washington, DC — Coalition of State Rheumatology Organizations (CSRO) physicians are voicing concern for patients who will fall victim of a dangerous new prescription policy. New requirements from BlueCross BlueShield (BCBS) of Tennessee, which may be a bellwether for other insurers, are reversing the trend providers have achieved in keeping prices down for physician administered medications.
Normally provider administered drugs are obtained via a “buy and bill” system where a provider purchases medication and bills the insurance company under a patient’s medical benefit. The new BCBS policy moves the acquisition of these administered medication away from the physician to the patient’s pharmacy benefit, handled by pharmacy benefit managers (PBMs).
The Centers for Medicare and Medicaid Services (CMS) dashboard purports that prices of Part D medications, those managed by a PBM, rise at much faster rates than physician “buy and bill” Part B medications.
“Now PBMs and insurers are integrated, they finally have the chance to move payments away from the medical side and put it on the pharmacy side, where more money is made with rebates and hidden fees,” said Dr. Madelaine Feldman, president of the CSRO.
“This policy is about one thing, profits,” Dr. Feldman, continued. “PBMs construct formularies encouraging pharmaceutical manufacturers to raise prices of drugs. The higher the price, the more money PBMs make, resulting in PBMs choosing higher priced drugs for the preferred tier.”
Another consequence of this new policy will be that physicians will no longer be able to infuse patients in their office. Dr. Robert Levin of the Alliance for Transparent and Affordable Prescriptions (ATAP) added, “We make decisions based on the needs of our patients, including how and where care is given. Needlessly driving up prices and making treatments more complicated to obtain is moving health care in the wrong direction. Patients deserve better.”
“Patients will be increasingly forced into expensive sites for care such as hospitals or where there is no direct supervision by physicians, nurse practitioners, or physician assistants,” said Dr. Aaron Broadwell, rheumatologist from Shreveport, Louisiana.
The CSRO is comprised of 43 state and regional professional rheumatology societies formed to advocate for excellence in rheumatologic disease care and ensure access to the highest quality care for the management of rheumatologic and musculoskeletal diseases.
