If you’ve never spent time in an oncology or rheumatology clinic, you might not realize how many of today’s most important medicines are administered right in a physician’s office.
These aren’t your run-of-the-mill prescriptions you can pick up at your local pharmacy. They’re complex medications that must be administered under close medical supervision, such as chemotherapy infusions and biologic therapies to treat a range of autoimmune diseases.
How Medicare reimburses for these treatments is hugely important for both physicians and patients. That’s why Congress needs to act now to protect Medicare beneficiaries’ access to life-saving therapies.
The Protecting Patient Access to Cancer and Complex Therapies Act of 2025 (H.R. 4299) protects patients and keeps doctors from being caught in the middle of price negotiations. Here’s why that matters.
Under current policy, when a drug is subject to government price negotiation, physician reimbursement shifts from average sales price (ASP) to something called the “Maximum Fair Price.” On paper, that may sound straightforward. In practice, it creates enormous financial risk for physician practices – especially independent ones.
Part B drugs aren’t free samples delivered to our door. Physicians purchase them upfront, store them properly, and administer them safely, all while assuming large financial risks until they are reimbursed. A small add-on payment (the “plus 6%”) helps cover real overhead: nursing staff, pharmacy handling, storage, compliance, and the fact that not every dose can be perfectly accounted for. When reimbursement drops but those costs remain, something has to give.
An independent analysis found that Part B add-on reimbursements could fall by as much as 61% as a result of drug price negotiations. Over time, those cuts could total tens of billions in reduced physician reimbursement. For large hospital systems, absorbing those losses may be painful – but possible. For small and mid-sized independent practices, however, it can be an existential crisis. Not only is the add-on payment, which is intended to cover practice overhead costs, cut, but our acquisition costs for these drugs will not drop in tandem with the reduced drug reimbursement that will come as a result of price negotiation. This means that for affected drugs, independent practices may face a difficult choice: lose money by infusing a patient with a necessary treatment, or refer the patient elsewhere for their treatment, often a hospital outpatient infusion clinic where the physician who knows the patient best is not available to oversee the treatment.
We don’t want to make decisions based on spreadsheets, but if a practice must choose between providing a medication at a loss or referring patients elsewhere, that’s not a theoretical dilemma. It’s a matter of survival. When independent clinics close or consolidate, patients don’t win. Care shifts to hospital outpatient departments, which are typically more expensive. Travel times increase. Infusion chairs become harder to access. Not to mention how rural and underserved communities are hit first and hardest.
Rheumatologists treat patients with severe autoimmune diseases that can destroy joints and organs if not controlled. Oncologists treat cancers where timing and continuity of therapy can mean the difference between remission and progression. The majority of our patients are older, medically fragile, and they need care close to home.
H.R. 4299 doesn’t undo drug price negotiation or eliminate projected Medicare savings. What it does do is ensure that physicians aren’t financially penalized for policies they don’t control. It removes independent clinics from the middle of the price negotiation occurring between the government and the drug manufacturer. It ensures that a well-intentioned initiative to reduce drug costs does not backfire by harming patient access. This is about more than accounting formulas. It’s about keeping infusion services available in community settings. It’s about preventing further consolidation into hospital systems. It’s about making sure seniors can continue receiving cancer treatment or autoimmune therapy from the doctors who know them best.
Independent medicine is already under strain from years of reimbursement pressure. We’ve watched as colleagues sell practices or close doors because the math no longer works. Adding another layer of unpredictable reimbursement cuts will only accelerate that trend.
We support responsible efforts to lower drug costs. Patients deserve affordability. But reforms should not force community physicians to choose between financial insolvency and discontinuing care. H.R. 4299 offers a practical fix. It allows policymakers to pursue drug pricing reforms without destabilizing the very practices that deliver these complex therapies.
At the end of the day, our responsibility is to the people sitting in front of us in the exam room and infusion chair. They should never have to wonder whether they’ll lose access to their trusted physician because of a reimbursement formula.
Congress can prevent that uncertainty. We hope they will act quickly.
Dr. Chris Phillips, an American College of Rheumatology leading rheumatologist, and Dr. Martin Palmeri, a Fellow of the American Society of Clinical Oncology.
