Oncologists joined with cancer organizations in Washington, D.C., today to denounce proposed changes for chemotherapy reimbursement in the Medicare reform bills being debated by the House and Senate.
The net effect of the current proposals could be as much as $500 million coming out of the system, or a 30% cut to cancer care coverage under Medicare, according to the American Society of Clinical Oncology, which represents about 20,000 cancer doctors.
Oncologists say they would be forced to cut back or even eliminate care, which would have a deep impact on access, as more than 80% of chemotherapy treatment is provided in outpatient settings.
John Rainey, M.D., who practices oncology with five-physician Louisiana Oncology Associates, based in Lafayette, La., says his group would have to close its four satellite clinics if the Medicare cuts for chemotherapy drugs go through.
"If patients don't have access, then I'm not sure what I'm here for," Rainey says. "I got into this business to take care of patients. I can't do that if this bill passes."
Currently, cancer doctors often purchase drugs below the amount paid by Medicare and use the "extra" money to offset underpayments for chemotherapy administration and other essential cancer treatment services such as oncology nurses, pharmacists, equipment, counseling and patient support.
The House bill that came out of the Ways and Means Committee creates a new system for payment of chemotherapy drugs in an attempt to fix the longstanding issue of overpayment for those drugs by Medicare under the current average wholesale price (AWP) system. The new system lets oncologists choose between a competitive bidding process or the average selling price (ASP) of the manufacturers.
The Energy and Commerce measure includes the choice between competitive bidding and ASP plus 12%. A single reconciled bill is scheduled for full House debate on Thursday. The Senate bill being debated this week would reimburse 85% of AWP, down from the current reimbursement of 95% of AWP.
While all the bills cut payment for chemotherapy drugs, they include an insufficient increase for patient service reimbursement, according to ASCO and some members of Congress.
"It is not only not good, it is knowingly flawed," says Rep. Charlie Norwood (R-Ga.), of the House proposal.
Norwood is co-sponsor with Rep Lois Capps (D-Calif.) of the Quality Cancer Care Preservation Act (HR 1622), which would adjust chemotherapy drug reimbursement policies while covering the full cost of administering chemotherapy and establishing reimbursement for related services provided by oncologists. Sen. Sam Brownback (R-Kan.) is sponsor of a companion bill in the Senate (S 1303).