Dr. Holton on pharmacy benefit manager reform and urology

Opinion
Video

"The Inflation Reduction Act has changed the landscape, and we really still don't understand what those implications are going to be," says Mara R. Holton, MD.

In this video, Mara R. Holton, MD, discusses the biggest story in health policy that urologists should be aware of. Holton is a urologist with AAUrology in Annapolis, Maryland and serves on the LUGPA board of directors.

Transcription:

What is the single biggest story in health policy that urologists should be aware of?

There are so many. I guess the number 1 would be pharmacy reform, probably Part B and Part D. The Inflation Reduction Act has changed the landscape, and we really still don't understand what those implications are going to be. They've just announced the first set of medications that will be impacted by the Inflation Reduction Act, but again, that's really going to take some time to ferret out what that will mean to our practices. The expanded development and applicability of customized care utilizing oral oncolytics—and now I'm referencing Part D applicability and reform—has really been a game changer. I think those of us who are engaged in the care of advanced oncology patients see the extension both in quality of life and quality of life that these drugs are offering, but they are expensive. And the concern is that with the change in the regulations regarding in-office dispensing, that you're now winnowing access to these types of therapies for patients. So a lot of challenges on the pharmacy side. I do think that always we focus on the unsustainable physician fee schedule. Fundamentally, we have a fee schedule that is not tied to any economic indices and is mandated to have budget neutrality. That's, candidly, insane, given that every other metric and every other input has increased precipitously over that 20, 30-year time interval. Again, we have seen at the congressional level, some attention to that and recognition that that does need to change. But that's not going to change without providers advocating on behalf of themselves. Tying into that, I think, are some really interesting things we're seeing, and I don't mean in good ways, in work force shortages and provider burnout, as well as collective bargaining with physicians. So what had been utterly inconceivable a decade or even a year or two ago, is now starting to happen. As we're seeing this decline in reimbursement, the shortage is becoming more remarkable. And then post-COVID really just, tons of people exiting the work force. So there's a tremendous amount going on. And again, as it pertains to providers, advocating on behalf of themselves, taking time out of their clinical practice to do so, we are seeing more and more of that, and that is needed more and more desperately, right?

This transcription was edited for clarity.

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