The American College of Rheumatology (ACR) is sounding the alarm over a proposed CMS rule that would codify the Medicare Drug Price Negotiation Program — warning it could create a "payment gap" that threatens access to biologic infusions for rheumatology patients. For the first time, Part B drugs administered in physician offices are included in the negotiation program, with new prices set to take effect in January 2028.

The crux of the issue: Medicare Part B currently reimburses physician-administered drugs at average sales price (ASP) plus 6%. Under the new rule, that shifts to maximum fair price (MFP) plus 6% — but drug acquisition costs for practices won't necessarily drop at the same rate. The ACR warns this mismatch could force independent practices, particularly in rural communities, to close their infusion centers and redirect patients to higher-cost hospital settings.

Key Takeaways:

• Drugs newly subject to Part B negotiations include Orencia, Cosentyx, Xeljanz, and Cimzia
• The ACR also flagged a provision that could limit coverage based on route of administration (e.g., IV vs. subcutaneous), potentially undermining shared clinical decision-making
• The ACR supports H.R. 4299, the Protecting Patient Access to Cancer and Complex Therapies Act, which would close the reimbursement gap via manufacturer rebates

Why it matters: Lower drug prices sound like a win, but if the policy inadvertently shuts down office-based infusion centers, patients — especially those in rural areas — could end up paying more and traveling farther for care. The ACR is calling on CMS to address these structural concerns before the rule takes effect.