Every day, infusion centers in New Jersey provide essential care to patients managing chronic conditions through timely access to infusion therapies. For many individuals with chronic diseases, local community-based infusion care is critical to maintaining health stability and avoiding crises. As an executive at a local infusion center in South Jersey who sees the impact of infusion therapies on a daily basis, I am deeply concerned about impending policy changes that could jeopardize this access.
Beginning in January 2028, Medicare will implement a new drug pricing framework under the Inflation Reduction Act, and will negotiate “Maximum Fair Prices” for certain infused medications covered under Medicare Part B. As outlined by the Centers for Medicare & Medicaid Services, provider reimbursement for these selected drugs will shift from the current Average Sales Price + 6% formula, which helps cover costs associated with drug acquisition, storage, handling, staffing, and administration, to MFP + 6%.
For community-based infusion centers like ours, which purchase medications upfront, this shift could significantly compress margins. Analyses indicate that the effective add-on payment could decrease by an average of 47% for affected therapies, a reduction that is not sustainable long-term. If implemented without adjustment, this policy risks forcing many infusion centers in New Jersey and nationwide to limit or discontinue services for certain therapies, potentially leading to closures.
As Chief Compliance Officer for Arthritis and Rheumatology Associates of South Jersey and Infusion Centers of South Jersey, I know that our centers serve as trusted community sites of care, offering prompt, compassionate, and specialized treatment. Without these options, patients may face delays in hospital outpatient departments, which are often more crowded and can result in substantially higher costs for the same therapies, and studies show differentials ranging from significant percentages to several times more than community settings.
This impact is especially acute for patients with serious autoimmune conditions, such as rheumatoid arthritis, psoriasis, and lupus. Delayed or disrupted access to affordable infusions can lead to health deterioration, lost productivity and an increased burden on families.
Congress has a viable path forward to address these issues without compromising Medicare savings. The Protecting Patient Access to Cancer and Complex Therapies Act, introduced in the U.S. House of Representatives, corrects structural concerns in the Medicare drug pricing reforms while preserving patient access. It removes providers from bearing the direct impact of negotiated price reductions by requiring manufacturers to provide payments bridging the difference between ASP and MFP, plus appropriate add-ons. This approach ensures Medicare achieves intended savings, patients benefit from lower cost-sharing based on MFPs, and providers can continue administering therapies across Medicare and commercial plans. The bill also excludes MFPs from ASP calculations, preventing broader systemic disruptions.
Advancing PACTA would safeguard timely, community-based care in New Jersey while aligning with the Inflation Reduction Act’s goals. I respectfully urge Sens. Andy Kim and Cory Booker, along with Representatives Herb Conaway, Jeff Van Drew and Donald Norcross, to support and advance this legislation to protect the millions of patients relying on community infusion centers.
Sean Weiss is the Chief Compliance Officer at Arthritis and Rheumatology Associates of South Jersey and Infusion Centers of South Jersey. The views expressed in this piece are solely those of Weiss and do not reflect the views of any organizations with which he is affiliated.
