CMS lacks the authority to implement its proposed reimbursement changes for chemotherapy drugs and should withdraw the proposal "due to legal, procedural and technical objections," says the American Society of Clinical Oncology.
Currently, Medicare pays doctors 95% of the average wholesale price (AWP) for covered drugs, including some chemotherapy drugs. CMS Administrator Thomas Scully and others have characterized the system as one that overpays doctors for drugs in order to supplement under-reimbursed office expenses related to administering the drugs.
CMS published its proposed rule change in the Federal Register August 20. ASCO filed its comments (available online) on Oct. 10.
ASCO president Margaret Tempero, M.D., agrees that the reimbursement system is flawed and should be reformed. "But the CMS proposals, if enacted, will create significant barriers to access to quality cancer care for Medicare beneficiaries," Tempero says in a written statement.
The draft rule offers four approaches to change the process by which physicians are paid for drugs covered by Medicare:
- Medicare would pay the same price as private insurers for covered drugs.
- Medicare would apply a 10% to 20% discount from AWP in 2004.
- Medicare would use existing sources for market-based process and develop other sources, such as drug price catalogs, to monitor future market changes.
- Medicare would establish a competitive bidding process and require drugmakers to report their average sales prices (ASP).
ASCO objects to each of the four approaches:
- Under Option 1, CMS does not adequately define comparable circumstances with private plan reimbursement.
- Under Option 2, CMS's proposal to pay a percentage of historical rather than current AWPs could lead to reimbursement that is lower than the prices physicians' pay.
- Option 3 lacks specifics.
- "The explanation of CMS's proposal for competitive acquisition (Option 4) is so incomplete that informed comment is impossible to provide."ASCO says legislative action rather than an administrative ruling is a more appropriate way to address the drug reimbursement problem. A congressional conference committee currently is negotiating possible solutions proposed in House and Senate versions of a Medicare reform bill.