By Brittney Fairman, Policy Analyst, ACCC
On Tuesday, May 17, the U.S. House Energy and Commerce Committee Subcommittee on Health held a hearing titled “The Obama Administration’s Medicare Drug Experiment: The Patient and Doctor Perspective,” which focused on CMS’ proposed Medicare Part B Drug Payment Model. The Subcommittee heard from witnesses representing the provider and patient communities, including:
- Debra Patt, MD, MPH, MBA, Vice President of Texas Oncology and Medical Director of The US Oncology Network;
- Marcia Boyle, President and Founder of the Immune Deficiency Foundation;
- Michael Schweitz, MD, FACP, MACR, National Advocacy Chair of the Coalition of State Rheumatology Organizations;
- Heather Block, a patient advocate; and
- Joe Baker, President of the Medicare Rights Center.
Notably, the hearing echoed many of the concerns ACCC and fellow stakeholders have been voicing since CMS released the proposal in early March. Key takeaways include:
CMS is operating under a false premise that there are always less costly therapeutic equivalents available to treat patients. In the case of oncology, treatment situations where there are true clinical substitutes are “few and far between,” Dr. Patt pointed out. When a therapeutically equivalent drug does exist, those drugs are not always available to every clinician nor are they always most conducive to a patient’s specific treatment plan.
The proposed demonstration will create barriers to patient access and have a disproportionate impact on rural areas. With a lack of appropriate safeguards, healthcare providers fear the demonstration program would create additional financial pressures that would push rural or small physician practices out of business. For patients in rural areas – or patients that require more expensive therapies – this may cause difficulty in accessing oncology care.
CMS’ proposal is akin to an involuntary clinical trial. Witnesses and Committee members pointed out that CMS’ experiment is not unlike a clinical trial, requiring participation of providers and their patients for the purposes of data collection. However, unlike a clinical trial, participation is involuntary and the proposal lacks critical patient safeguards – patients may never know if their provider is operating under a control or experimental arm of CMS’ demonstration. This randomized trial will, unknowingly and unwillingly, limit patient access to needed care.
Average Sales Price (ASP), by definition, is an average. Many community oncologists – often smaller practices – are not able to gain price advantages and are currently paying well above ASP for Part B drugs. Any further reductions to reimbursement will make it impossible for providers to cover the acquisition cost of many, if not most, cancer treatments.
Witnesses also addressed a series of “carve-outs” that have been discussed by policymakers, including for oncology providers, the Oncology Care Model (OCM) participating practices, or rural providers. Dr. Patt, however, pointed out that “there’s no right way to do the wrong thing.” Most witnesses called for a full withdraw of CMS’ proposal.
These points and more can be found in ACCC’s comments, submitted to CMS in early May. ACCC is continuing to monitor Congressional efforts on the CMS proposal.