July 2022  

In this issue we feature:

  • Fly-in Recap
  • LUGPA and coalition oppose use of step therapy and prior authorization in Medicare Part B
  • Additional LUGPA recommendations adopted by GOP Healthy Futures Task Force
  • FTC launches investigation into PBMs
  • Medicare payments decrease by 1% effective July 1
  • Phase 3 Provider Relief Fund reporting is now open
  • No Surprises Act Information and Resource Hub

Fly-in Recap   

The Political Affairs Committee and LUGPA members were back in Washington, DC in June as we continued to promote our 2022 Legislative and Regulatory Agenda. This fly-in focused on three key issues: making telehealth waivers permanent; protecting physician practices in any drug pricing reform of physician-administered Part B drugs; and advancing site neutrality policies that level the playing field between physician practices and hospitals. We are getting great traction on our issues. The GOP Healthy Futures Task force, which is outlining an agenda for the next Congress should Republicans retake the House of Representatives, has adopted our ideas on site neutrality for Part B drug administration reimbursement and beneficiary copayment caps between physician office and hospitals, as well as reforming the inpatient only list.

In June, LUGPA members met with the following Members of Congress:

  • Representative Larry Bucshon (R-IN) | House Energy and Commerce Subcommittee on Health
  • Representative Buddy Carter (R-GA) | House Energy and Commerce Subcommittee on Health, Doctors Caucus
  • Representative Neal Dunn (R-FL) |a urologist and former LUGPA member!; House Energy and Commerce Health Subcommittee Member, Doctors Caucus
  • Representative Steven Horsford (D-NV) | House Ways and Means Subcommittee on Health
  • Senator Mark Kelly (D-AZ) | Senate Special Committee on Aging
  • Representative Mariannette Miller-Meeks (R-IA) | Doctors Caucus
  • Representative Markwayne Mullin (R-OK) | House Energy and Commerce Subcommittee on Health
  • Representative Greg Murphy (R-NC) | a practicing urologist and new member on House Ways and Means Subcommittee on Health, Doctors Caucus
  • Representative Raul Ruiz (D-CA) | House Energy and Commerce Subcommittee on Health, Doctors Caucus
  • Representative Adrian Smith (R-NE) | House Ways and Means Subcommittee on Health
  • Representative Lloyd Smucker (D-NV) | House Ways and Means Committee
  • Senator Todd Young (R-IN) | Senate Finance Committee

In addition to the lawmakers listed above, fly-in participants met with health aides and staff members of the House Ways and Means and Energy and Commerce Committees and the Senate Finance Committee.

We have another batch of meetings scheduled for some of our physician leaders next week and hope to make even more progress on the advocacy front, particularly as it pertains to reimbursement.  Last week CMS released its proposed physician fee schedule rule, which included substantial cuts to physician reimbursement. We will be working with others in the physician community to block these cuts and provide a sustainable annual payment update.

LUGPA encourages members to attend fly-ins to let Members of Congress and their staff know what is going on in your practices. LUGPA physicians and senior administrators who have attended in the past say that they find the experience to be worthwhile and essential to their understanding of the political process. If you are interested in attending a fly-in with LUGPA in Washington, DC, or would like more information, contact Morgan Cox in the LUGPA office ([email protected]).

First time attendee Nathan Diller of Brandywine Urology had this to say about his experience: “It is not every day one has the privilege of sitting across from a US Representative or US Senator and be able to explain how the decisions he/she are making are impacting one’s ability to care for patients and the community. The LUGPA fly-in is precisely that opportunity. As a first time participant, attending the June Fly-In, it was an immensely rewarding experience to be able to explain how various health policy decisions are impacting my practice’s ability to remain independent and deliver high quality care to my community. It is an experience I encourage everyone to consider actively participating in.”

With the utmost gratitude, the LUGPA Political Affairs committee wants to thank the physicians and administrators of the following groups whose efforts made the June fly-in possible:

AAUrology
Advanced Urology Medical
Arkansas Urology
Associated Urologists, PA
Dayton Physicians Network
First Urology
Garden State Urology
Genesis Healthcare Partners
Golden Gate Urology
MidLantic Urology
NEO Urology
Premier Medical Group of the Hudson Valley
The Urology Group
Urological Surgeons of Northern California, Inc.
Urology Associates of Central California
Urology Associates of the Central Coast
Urology of Indiana

 

 

divider

LUGPA and coalition oppose use of step therapy and prior authorization in Medicare Part B

LUGPA has joined more than 70 provider and patient organizations urging CMS to change current policy that allows for the use of step therapy and prior authorization protocols to manage drug utilization by Medicare Advantage plans. This is an issue LUGPA has focused on, as there are concerns that patients are at risk under “fail-first” step therapy requirements. LUGPA opposes any policies that restrict appropriate access to drugs, including step therapy and prior authorization and will continue to work with aligned stakeholders in urging CMS and Congress to reverse current CMS policy.  Read the sign-on letter here.  

divider

Additional LUGPA recommendations adopted by GOP Healthy Futures Task Force

In June, the Doctor-Patient Subcommittee of the GOP Healthy Futures Taskforce has released recommendations which pick up some of LUGPA’s legislative priorities, including less bureaucracy for prior authorization and step therapy, specifically:

  • Reform prior authorization, which is a source of delayed patient care due to its misuse. Patients, in consultation with their doctors, should be in the driver’s seat for their own medical decisions. Doctors – not distant health care bureaucrats - know what is best for their patients and serve as the first line of defense for a patient’s unique medical needs.
  • Improve care for seniors by streamlining and standardizing the use of prior authorization to encourage real-time decisions, eliminate unnecessary delays in care, and improve overall health outcomes.

divider

FTC launches investigation into PBMs

On June 7, the Federal Trade Commission announced a formal inquiry into the role of PBMs in the pharmaceutical marketplace after a unanimous vote from its commissioners. The agency has ordered the six largest pharmacy benefit managers to provide information and records on their business practices in order to scrutinize their impact on the accessibility and affordability of prescription drugs. Specifically, the inquiry will focus on:

  • fees and clawbacks charged to unaffiliated pharmacies.
  • methods to steer patients towards pharmacy benefit manager-owned pharmacies.
  • potentially unfair audits of independent pharmacies.
  • complicated and opaque methods to determine pharmacy reimbursement.
  • the prevalence of prior authorizations and other administrative restrictions.
  • the use of specialty drug lists and surrounding specialty drug policies.
  • the impact of rebates and fees from drug manufacturers on formulary design and the costs of prescription drugs to payers and patients.

The full statement is available on the FTC website.

divider

Medicare payments decrease by 1% effective July 1

The 2% payment cut temporarily suspended in 2020 and 2021 due to COVID relief packages has been phased back in. The reduced rate is effective for services provided on or after July 1.

divider

Phase 3 Provider Relief Fund reporting is now open

The Provider Relief Fund Reporting Portal for Phase 3 is now open. Providers who received one or more Provider Relief Fund payments exceeding $10,000 in aggregate between January 1 and June 30, 2021 are required to report their use of funds by September 30.

divider

No Surprises Act Information and Resource Hub

As a reminder, LUGPA has assembled a page of helpful links and resources to assist urology practices in the implementation of the No Surprises Act. The page is frequently updated with new information as it becomes available. Among the latest updates are two recent presentations:

Click here to access the No Surprises Act Information and Resource Hub

divider