Why H.R. 4299 Matters for People Living with Migraine
Protecting Access to Migraine Treatment
People living with chronic migraine often rely on regular treatment from neurologists and headache specialists to help prevent attacks and manage their disease.
One important treatment is Botox, which is given by a trained clinician about every 12 weeks for eligible patients with chronic migraine.
A change in Medicare payment policy could make it harder for some community doctors to continue offering Botox and other physician-administered Part B treatments in their offices.
What Could Happen?
Under the Medicare Drug Price Negotiation Program, the price Medicare pays for certain medicines will be reduced. Botox is one of six medicines with Medicare Part B coverage selected for Medicare negotiation, along with Cimzia, Cosentyx, Entyvio, Orencia, and Xolair; their negotiated prices are scheduled to take effect in 2028.
Lower prices can help patients and Medicare save money. But there is an unintended problem: clinicians may also receive significantly less reimbursement for providing these medicines, even though many of their costs for purchasing, storing and administering the treatment remain.
If practices cannot afford to provide a treatment, they may have to:
- Stop offering certain medicines in their offices;
- Send patients to hospitals or other treatment locations;
- Ask patients to travel farther for care; or
- Change how or where patients receive treatment.
Patient and clinician groups – including those outside of the migraine community such as oncology and rheumatology – are warning that these payment changes could make it difficult for community medical practices to continue stocking certain Medicare Part B medicines.
Why Does This Matter for Someone Living with Migraine?
For a person who has finally found a migraine treatment that works, keeping that treatment accessible and on schedule matters.
Having to find a new doctor or treatment location could mean:
- Longer travel;
- More time away from work or family;
- Delays in treatment;
- Disruption of an established relationship with a headache specialist;
- More costs for patients who are forced to access emergency room services; and
- Additional stress for patients and caregivers.
These challenges can be especially difficult for people who live in rural communities or areas where headache specialists are already hard to find. Losing community-based specialty care can leave patients traveling farther and with fewer local treatment options.
For people living with migraine alongside conditions such as rheumatoid arthritis, Crohn’s disease, asthma, cardiovascular disease, or other neurologic disorders, these concerns may be even greater, as they may rely on multiple therapies that could be affected by the same reimbursement challenges.
What Would H.R. 4299 Do?
The Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299) is designed to fix this problem.
The bill would allow doctors to continue receiving adequate reimbursement for providing these medicines while preserving the lower costs intended for Medicare patients and taxpayers.
The Bottom Line
People with migraine should not lose access to effective treatment simply because their doctor’s office can no longer afford to provide it.
H.R. 4299 would help protect access to community-based care and allow patients to continue receiving treatment from the clinicians they know and trust.