OPINION: Time is running out on health care lifeline for New Mexicans

Tens of thousands of New Mexicans are diagnosed with cancer and other serious illnesses every year. A disproportionate number are seniors, and they mostly rely on Medicare to access the advanced therapies they need.

Unfortunately, accessing that care could soon become far, far more difficult. A well-intended provision of the Inflation Reduction Act is set to slash reimbursements for the providers who administer these life-saving treatments.

If lawmakers don’t intervene, it will force independent physician practices and infusion centers to close or cut services — jeopardizing access to care for patients throughout New Mexico.

The Inflation Reduction Act allows Medicare to negotiate drug prices with manufacturers.

Starting in 2028, the act will apply negotiated prices to medicines covered through Medicare Part B. That’s the part of Medicare that pays for more complex drugs — such as chemotherapies that have to be delivered through an IV — administered in a clinical setting.

Doctors and infusion centers buy these drugs up front — typically through wholesalers and other intermediaries that set prices independently — and use them to treat patients. Right now, Medicare reimburses physicians for the average sales price of the medicines, plus a 6% add-on to cover overhead costs.

That reimbursement system works well currently. But it’s about to stop functioning. Because as the IRA is currently written, doctors and clinics will only be able to seek Medicare reimbursement for the lower negotiated price of the drug, plus the 6% add-on.

A recent study found that medical providers nationwide could lose up to $37 billion in total over five years due to falling Part B reimbursements.

That would force many to make difficult decisions — reducing services, limiting the number of patients they can treat, or shutting down entirely.

New Mexico, where over a quarter of the population lives in rural areas, would be especially hard hit. Clinic closures would force rural patients, many of whom are elderly or immune-compromised, to travel hours each week to receive the lifesaving treatments they need.

This would’ve been disastrous for patients like my late father, who received treatments for his brain tumor at a small clinic about half an hour from his house. If the new reimbursement scheme takes effect, and many of New Mexico’s small clinics are forced to close, people in my father’s community would likely have to make a four-hour round trip to Albuquerque every week — or even every few days.

Thankfully, lawmakers have a way to prevent this.

Passing the Protecting Patient Access to Cancer and Complex Therapies Act would enable medical providers to continue receiving reimbursements under the current system. Instead, drug manufacturers would be required to issue rebates to the government to make up the difference between the negotiated Medicare price and the average sales price.

Patients can continue to receive the care they need without being forced to travel longer distances or pay higher prices. Physicians and infusion centers would be able to remain financially stable. Taxpayers would even save an estimated $3.3 billion over the next decade, on top of the savings from the negotiations themselves.

The Protecting Patient Access to Cancer and Complex Therapies Act is a common-sense solution that protects patients, preserves access to essential treatments, and safeguards the financial stability of physicians and infusion clinics. It deserves the full-throated support of our congressional delegation.