A new bipartisan bill proposes amendments to ensure more “appropriate” drug and biologicals payments for community oncology practices, which are struggling to provide the demand for care, under the Medicare Part B program.
H.R. 905, introduced by Rep. Ed Whitfield (R-Ky.) and Rep. Gene Green (D-Texas), would amend title XVIII of the Social Security Act to ensure more appropriate payment for drugs and biologicals under Part B, according to the Community Oncology Alliance (COA). The bill calls for excluding customary prompt pay discounts extended to wholesalers from the manufacturer’s Average Sales Price (ASP), the COA said.
“The Community Oncology Alliance strongly endorses this bipartisan House effort to support cancer care,” said Ted Okon, executive director of the COA, in a statement. “The cancer community is looking for solid, bipartisan efforts from Congress to remedy a long-standing inequity that is threatening the survival of community oncology practices.”
The current ASP methodology used to calculate Medicare Part B reimbursement artificially reduces payment for cancer drugs to community oncology practices. The purchase cost exceeds the reimbursement, forcing practices to pay out of pocket when treating cancer patients with chemotherapy, the COA reported.
The bill would exclude distributor prompt pay discounts from the ASP methodology. This plan is consistent with existing policy and will create greater uniformity among federal healthcare programs, as these terms already are excluded from the Medicaid Average Manufacturer Price (AMP) methodology, according to the COA.
The COA said 84% of Americans receive care in community cancer clinics.
The cancer care delivery system is suffering from Medicare cuts to payment for cancer drugs and essential services, the COA indicated. In the next decade, there will be an oncologist shortage for one in every four cancer patients, the COA said.
“This is a national problem that is affecting access to cancer care treatment,” Green said in a statement. “We must address the prompt pay issue to preserve the practices providing care in cancer patients’ own communities. Advances in treating cancer are meaningless if patients cannot access the care and oncologists cannot provide the care.”
Bipartisan bill looks to tweak some Medicare Part B payments via IFAwebnews .