Bush
Administration Proposed Cancer Care Cuts
Could Reach $27.6 Billion
Centers for Medicare & Medicaid
Services
Proposes The Single Largest Cancer Care Cut Ever
WASHINGTON, Aug. 21, 2003 -- A proposed
rule issued Friday by the Centers for Medicare & Medicaid Services
(CMS) could severely disrupt cancer care for Medicare beneficiaries in
this country by cutting up to $27.6 billion from physicians'
reimbursements for chemotherapies and other drugs over the next 10 years.
The proposed rule, which would go into
effect January 1, 2004, would significantly change the way the Medicare
program currently provides coverage for cancer care, including
cancer-fighting drugs and treatment services.
The CMS rule, published August 20 in the
Federal Register, was announced as Congress is considering a Medicare
package that could cut up to $16 billion of Medicare funding for cancer
care over the next 10 years, according to estimates released by the
Congressional Budget Office.
Cancer care advocates across the country
are concerned that the deep cuts proposed in the CMS rule will severely
impact patient access to comprehensive cancer care.
"Under this CMS rule, government
reimbursement for cancer therapies will fall far below the cost of
providing care, placing tremendous strain on the community-based cancer
care delivery system," said Ted Okon, Co-Executive Director of the
Community Oncology Alliance, which represents community-based cancer
clinics across the U.S. "This rule would impose the single largest
cancer care cut ever."
CMS is seeking comment on four potential options:
1. "Comparability": Under this model, Medicare would pay for covered
drugs at the lower of existing Medicare payment levels or the amounts
paid by preferred provider organization and indemnity plans operated
by Medicare carriers;
2. "Average Wholesale Price (AWP) Discount": Under this model (which is
based on the Senate-passed proposal), Medicare would reimburse drugs
at 10 to 20 percent below AWP in 2004 and undertake further payment
updates in subsequent years;
3. "Market Monitoring": Using existing (and dated) sources of market-
based prices (General Accounting Office and Office of the Inspector
General) and additional sources developed for this purpose, Medicare
would redefine AWP to be the price that CMS determines to be widely
available in the market;
4. "Competitive Acquisition Program and Average Sales Prices": Under this
model (which is based on the House-passed proposal), Medicare would
pay for drugs either to vendors under a Mandatory Vendor Imposition
(MVI)-style process or to physicians at a level defined as 100 percent
of the Average Sales Price of acquired drugs.
According to the American Cancer
Society's Facts & Figures for 2003, 1,334,100 new cases of cancer are
expected this year. Primarily due to an aging baby boomer population, many
in the cancer community expect a marked increase in new cancer cases
during the next ten years. Furthermore, 60 percent of all new cancers
diagnosed in any given year occur among Medicare beneficiaries.
"Instead of investing to meet the
growing needs of America's seniors and continue leading the world in
progressive cancer care, it's unfortunate that CMS is recommending we take
one huge leap back," said Steve Coplon, who is a practice
administrator and serves as Co-Executive Director of the Community
Oncology Alliance.
Approximately 80 percent of cancer care
is provided in convenient, high- quality, and cost-effective
community-based settings. It is these community- based cancer care clinics
that are severely threatened by the proposed CMS rule.
"This proposal would close many
clinics nationwide, forcing cancer patients -- especially those who live
in rural areas -- to travel long distances searching for treatment. What's
more, the cancer care facilities that are left will be overcrowded with
patients from clinics that have shut down, delaying crucial, life-saving
care for patients," said Dr. Kurt Tauer, a medical oncologist who
serves as President of the Community Oncology Alliance.
While CMS' proposed rule, as well as the
provisions in both the House and Senate Medicare drug prescription
legislation, would force deep cuts in community-based cancer care, some
Members of Congress understand the severe consequences the proposed cancer
cut cuts would cause, and are working toward a resolution. These Members
of Congress recognize what the cancer community has long acknowledged --
balanced reimbursement reform is necessary.
Medicare currently over-reimburses for
oncology medications, but significantly under-reimburses for the essential
services -- such as nursing care and assistance provided by pharmacists --
required to administer chemotherapy and other complex cancer medications.
To date, more than 170 concerned Members
of Congress have signed letters to the congressional leadership requesting
that the cancer cuts be replaced by a balanced approach to Medicare
reimbursement reform.
"These cuts would devastate the
best, most accessible cancer care system in the world and disrupt
treatment to millions of older Americans battling cancer," said
Margaret Watkins, R.N., director of clinical services for an oncology
group in Florida. "Forcing providers to dramatically reduce staff and
compromise the quality of the care we deliver is no way to treat patients
battling this disease. They deserve better than the Administration is
offering."
"As a cancer patient, I'm here to
tell you that quality care for cancer patients is a matter of life and
death," said Bud Dole, a cancer survivor from Midland, Texas, who
continues to undergo maintenance treatment. "Both the Administration
and Congress must work with the cancer community to find a remedy that
doesn't disrupt the care patients need and deserve."
Source: Community
Oncology Alliance
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