April 2025

     In this issue we feature: 

• Renewed Efforts to Protect In-Office Dispensing in Congress
• LUGPA Advocates for Preserving Public Input on HHS Regulations
• Physician Payment Reform & Continuing Resolution Update
• LUGPA Fly-In Updates & 2025 Legislative Priorities
• LUGPA Joins Coalition Effort to Cover Biomarker Testing in Delaware
• New Executive Order Strengthens Price Transparency
• CMMI Announces Alternative Payment Model (APM) Changes

Renewed Efforts to Protect In-Office Dispensing in Congress

LUGPA remains committed to protecting independent physician practices and ensuring patient access to essential medications. A key legislative effort toward this goal is H.R. 2484, the Seniors’ Access to Critical Medications Act, introduced by Representative Diana Harshbarger. This bill seeks to modernize in-office dispensing (IOD) regulations, remove unnecessary barriers that restrict timely patient access to prescribed treatments, and enable providers to best manage care for their complex patients.

Key provisions of the bill include:

• Caregiver Pick-Up – Authorizes family members or caregivers to retrieve prescribed medications on behalf of patients.
• Physician-Directed Medication Delivery – Allows physicians to mail or deliver Medicare Part D drugs to their patients, ensuring continuity of care and reducing unnecessary delays in treatment.
• Patient Safeguards – Limits eligibility to patients who have had a prior in-person visit with their physician and an established treatment relationship, ensuring responsible and appropriate medication distribution.
• GAO Study on Impact – Mandates a Government Accountability Office (GAO) review to assess the bill’s effects on patient care, medication adherence, and healthcare costs.

By modernizing these outdated restrictions, this legislation will enhance patient convenience, particularly for those with mobility challenges, while strengthening the role of independent physicians in care delivery. LUGPA strongly supports this bipartisan initiative and is actively working with lawmakers to secure additional cosponsors.

LUGPA Advocates for Preserving Public Input on HHS Regulations 

LUGPA is actively opposing recent efforts by the Department of Health and Human Services (HHS) to reduce public participation in the federal regulatory process. Specifically, the administration has rescinded the Richardson Waiver, a critical safeguard that previously ensured public input on regulatory changes affecting healthcare providers and patients.

This policy change limits transparency and weakens the ability of independent physicians to voice concerns about new healthcare regulations before they take effect. LUGPA believes that stakeholder engagement is essential for balanced, effective policymaking. We are working alongside key congressional leaders to restore transparency and ensure that independent practices have a say in regulatory decisions that impact their ability to deliver quality care.

Physician Payment Reform & Continuing Resolution Update

The ongoing Medicare reimbursement crisis continues to threaten the stability of independent practices. Since 2001, Medicare physician payments have declined by 29% when adjusted for inflation, putting severe financial strain on providers and limiting patient access to care. While Congress has provided short-term relief to keep Medicare physician payments level in the past few years, CMS cut 2025 physician pay by 2.83% relative to 2024, and Congress has failed to reverse that cut. Despite reports that the recent Continuing Resolution (CR) would provide relief from that cut, it was unfortunately not included. Without intervention, these reductions will further exacerbate workforce shortages and practice closures, particularly in underserved areas.

LUGPA is actively urging Congress to:

Reverse the 2025 Medicare Physician Fee Schedule (MPFS) cuts and establish a sustainable reimbursement model that keeps pace with inflation.

Pass bipartisan solutions such as:

• H.R. 879 (PROVIDE Act) – Aims to eliminate MPFS cuts and ensure stable physician payments.
• S. 891 (Bipartisan Primary Care & Health Workforce Act) – Extends key Medicare telehealth flexibilities and provides much-needed reforms to physician reimbursement structures.

LUGPA remains committed to securing legislative fixes that protect the financial viability of independent practices and ensure continued access to high-quality specialty care for Medicare beneficiaries.

LUGPA Fly-In Updates & 2025 Legislative Priorities  

LUGPA remains committed to advancing policies that support independent urology practices and enhance patient care. In 2025, our advocacy efforts will focus on:

• Sustainable Medicare reimbursement reforms that provide financial stability for independent physicians.
• Expanded in-office dispensing to streamline medication access for patients.
• Site-neutral payment policies to level the playing field between hospital outpatient departments and independent physician practices.
• Improved access to cancer screenings and specialty treatments through fair reimbursement structures and patient-centered policies.
• Development of physician-led alternative payment models (APMs) that promote high-quality, cost-effective care.

Key Advocacy Priorities for the April Fly-In

LUGPA’s April Fly-In will focus on:

• Medicare Physician Payment Stability & MACRA Reform – Advocating for policies that ensure fair and sustainable physician compensation.
• Protecting Patient Access to Part D Medications – Supporting legislation that safeguards the affordability and accessibility of physician-administered and self-administered treatments.
• Preserving ASP+6% for Cancer & Specialty Therapies – Pushing to reverse the pending cut to reimbursement rates for life-saving treatments.
• Advancing Site-Neutral Payment Reforms –Support policies aimed at leveling the playing field, ensuring continued patient access, and controlling costs.

LUGPA Joins Coalition Effort to Cover Biomarker Testing in Delaware 

In late March, LUGPA joined a coalition advocating for legislation in Delaware that would require state-regulated insurance plans to cover guideline-indicated biomarker testing. This measure aims to expand access to precision medicine, ensuring that patients with cancer and other diseases receive the most effective treatments based on scientific and medical evidence. By supporting this initiative, LUGPA continues its commitment to advancing patient-centered care and reducing barriers to innovative diagnostics.

New Executive Order Strengthens Price Transparency

A recent executive order strengthens federal healthcare price transparency regulations, ensuring hospitals and insurers provide patients with clear and accurate pricing information. These measures aim to enhance accountability and empower consumers by requiring:

• Mandatory pricing disclosures – Hospitals must publicly post prices for common procedures and treatments, allowing patients to compare costs before receiving care.
• Cost estimator tools – Insurers are required to offer real-time, user-friendly pricing estimates to help patients understand out-of-pocket expenses.
• Enhanced enforcement mechanisms – Stricter penalties for noncompliance, addressing widespread transparency failures, as current data shows only 21.1% of hospitals fully meet existing requirements.

LUGPA supports these reforms and calls for rigorous enforcement to promote competition, prevent price gouging, and ensure patients can make informed healthcare decisions.

CMMI Announces Alternative Payment Model (APM) Changes 

The Center for Medicare & Medicaid Innovation (CMMI) recently announced the termination of several Alternative Payment Models (APMs), including programs focused on primary care, kidney care, and drug cost containment. These changes raise significant concerns about the future of value-based payment initiatives and their impact on independent physicians who rely on stable and predictable reimbursement structures to provide high-quality care.

The discontinuation of these models underscores the need for specialty-specific APMs that better reflect the complexities of specialty care and align incentives with cost-effective, patient-centered treatment. LUGPA remains committed to advocating for the development of alternative payment models that support independent urology practices. We will continue engaging with policymakers to ensure physicians have viable pathways beyond the traditional fee-for-service system, preserving access to high-quality specialty care for patients.