Jennifer L. Mathieu on 2024 AMCP Legislative Priorities | AMCP 2024

Legislation that would carve out a separate category of coverage for prescription digital therapeutics in the Medicare and Medicaid programs remains a top priority for the Academy of Managed Care Pharmacy (AMCP), according to Jennifer L. Mathieu, senior vice president, professional and government affairs, for the organization

"This benefit category is necessary for coverage and reimbursement, which currently is done very piecemeal," Mathieu said in an interview with Managed Healthcare Executive prior to her presentation today at the 2024 AMCP Annual Meeting in New Orleans.

The Access to Prescription Digital Therapeutics Act was first introduced in 2022, and AMCP has been a constant backer of the bill, which would establish a payment methodology specific to digital therapeutics. Mathieu noted only digital therapeutics that had been reviewed and cleared by the FDA would be eligible for payment in the new category.

The organization's other legislative priorities include the Medicaid VBPs for Patients Act, which would codify elements of the multiple best prices rule issued by CMS, and the Equitable Community Access to Pharmacist Services Act, which would extend some rule changes concerning pharmacists made during the COVID-19 public health emergency and allow for reimbursement of pharmacists under Medicare Part B.

Mathieu said the Medicaid VBPs bill is priority "because addressing disparities and medication use and access is a top strategic priority for AMCP as an organization." The bill is supposed to make it easier for Medicaid programs to enter into value-based agreements for expensive cell and gene therapies.

Mathieu told MHE that AMCP is also pushing for appropriations that would lead to greater use of biosimilars.

Congress is considering legislation that would impose additional reporting requirements on pharmacy benefit managers (PBMs) and possibly ban some current business practices, such as spread pricing. Mathieu said "AMCP has not formally taken a position on any of the bills at this time."

"We are monitoring. We are updating our members. We are keeping very close tabs on the various pieces of legislation, she said.