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Issue Background

Access to In-Office Administered Biologics for Medicare Patients

Appropriate access and reimbursement for Self Administered Drugs (SADs) is essential to ensure that patients receive necessary medical care.  Increasing numbers of Medicare Administrative Contractors (MACs) are inappropriately determining that some biologics for arthritis treatements on their Part B formularies could be improperly moved to the self administration drug (SAD) list.  Unfortunately, this leaves our patients in a position of limited medical treatment options. Patients deserve to have access to the best medical care at the most affordable cost.  CRA opposes improper decisions like this and communicates its position with its local MAC and key physician decisionmakers.

CRA supports appropriate MAC decisionmaking regarding the SAD exclusion list.  Many Medicare beneficiaries are unable to self inject these medications, thus, placing thousands of our patients at risk.  Patients should have access to whatever treatment is most effective. The decision about which treatment, and treatment administration route is appropriate and medically necessary for the patient should be made by the physician and patient.