Proposed cuts in Medicare payments for cancer drugs will be nearly double Bush administration estimates, potentially limiting access to care, according to a survey of cancer doctors.
Payments from the government for some drugs will not equal the cost to most doctors, the American Society of Clinical Oncology said today. It has lobbied to restore funding that would be cut under last year's Medicare prescription drug law.
The average reduction in reimbursement for the medications will be 15%, according to the group's analysis of pricing information provided by community oncology practices. The administration said the cuts would not exceed 8% on average.
Cancer doctors have said the proposal could put some practices out of business, forcing patients to get their treatment in hospitals sometimes far from their homes.
"We believe it is not only our responsibility as oncologists to provide quality care, but also to let Congress and policymakers in Washington know that these cuts may be more significant than intended," said Margaret Tempero, M.D., the group's former president.
Proposed changes announced in July would save the government $530 million and Medicare beneficiaries $270 million next year, said Mark McClellan, M.D., administrator of the CMS. Medicare last year spent $10.5 billion on prescription medicines administered in physician offices and clinics.
The government has been paying the physicians up to twice what they should for certain medications, the administration said. Yet the government allowed the overpayments to continue because it acknowledged that doctors were underpaid for their practice expenses, such as nurses, equipment and treatment rooms.
McClellan said today that Medicare is working with cancer doctors and plans to add payments for administering the drugs, partly addressing their concerns. "The numbers and the impact are not included at all," in the ASCO study, McClellan said in an interview.
ASCO officials said the government has yet to make available information on those payments.
The doctors' group said its survey found several drugs for which proposed reimbursements are inadequate.
Three-quarters of cancer practices will spend more than Medicare will reimburse for epoetin, used to treat anemia, which is common among cancer patients, the survey found. The Medicare reimbursement for pamidronate, used for bone metastasis, won't cover the costs for 70% of practices.
More than half of cancer doctors say they will spend more than they are reimbursed for irinotecan, a treatment for colon cancer, and gemcitabine, used for lung and pancreas cancers.
Medicare won't pay for most prescription medicines until 2006, but it covers the cost of intravenous chemotherapy and other treatments that must be dispensed by medical professionals.
Doctors have long acknowledged that the payment system has been out of whack for cancer care administered in their offices. Several studies have documented that drug reimbursements were tied to an inflated price rather than to what doctors paid. The Medicare law called for the system to be fixed.
Cancer specialists and patient advocates have asked Congress essentially to freeze payments at current levels until various agencies complete studies of the new pricing system, expected in 2006.
Ketchum Communications, the public relations company working with the cancer doctors to call for a change in the Medicare law, also is the principal contractor employed by the administration to promote that same law.
The administration has spent $87 million on television ads, mailings and other means to promote the new law, most of it to tout prescription drug coverage that will be available through Medicare in 2006, the Health and Human Services Department said.