If you’re a gastroenterologist in private practice, there is legislation being considered in the U.S. Senate that could force your patients to seek care in the more expensive hospital setting.

While the Prescription Drug Pricing Reduction Act is largely focused on price transparency, access and affordability, it currently includes a proposal – in Section 102 of the bill – to include the value of coupons and other patient assistance programs in the calculation of Medicare’s average sales price (ASP) reimbursement formula.

If the proposal becomes law, it could be devastating for patients with conditions that need intensive medical management, such as cancer and rheumatoid arthritis, among other diseases and chronic conditions.

Dr. Michael Weinstein, president of the Digestive Health Physicians Association points out in a recent Morning Consult op-ed, that this would be particularly difficult for patients with Crohn’s and Colitis:

“Treatments for these conditions help people who are suffering from abdominal pain, persistent diarrhea, rectal bleeding, fever, weight loss and worse. The treatments are enormously complex, and the medications are expensive. As you can imagine, the coupon programs have become increasingly important in helping many patients continue with expensive treatments.”

Without the coupons, patients might be unable to afford these much needed medications, and if the ASP pricing falls due to inclusion of the value of the coupons, it may be difficult for physicians to continue providing the medications, as the reimbursement may not be enough to cover the initial cost of the medications.

This would be a hardship for many practices – which are already confronting reduced reimbursement as a result of the budget sequestration of 2013. In this environment, every bit of savings is important.

As a member of our group purchasing organization (GPO), we’re able increase the forecast purchase volume of a large group of practices, allowing us to negotiate lower prices for goods or services compared to what might be achievable by each individual GI practice. We negotiate with vendors for pharmaceuticals administered in-office, other medicines and equipment and supplies to get discounts normally available only to large health care systems.

Opening an in-office retail pharmacy is another approach that could lower costs and ensure your patients have access to the medication they need. If in-office retail pharmacies are allowed in the state in which you practice, there are lots of good reasons to open one inside your gastroenterology clinic. It is becoming a very popular way to both increase patient medication compliance and to lower costs for providers.

Joining a GPO can help independent practices weather changes in policy that might negatively affect their patients or their business, and it’s promising that neither the underlying Democratic bill in the U.S. House of Representatives nor the Republican substitute contain the coupon provision.

We hope that Congress realizes that including the value of coupons and patient assistance programs in the ASP formula would have the exact opposite impact of what the proposal is meant to achieve. This policy would force patients to seek care in the more expensive hospital setting, where Medicare and patients pay dramatically more for drug administration.

The Senate should eliminate Section 102 from the Prescription Drug Pricing Reduction Act and Congress should continue working on policy solutions that reduce costs for patients without weakening access to medications that improve their quality of life.