The United States Congress has come to the aid of Medicare patients and their providers to stop the harmful sequester cut important cancer drugs. Earlier today, a community of American cancer care organizations, including the American Society of Clinical Oncology (ASCO), Community Oncology Alliance (COA), ION Solutions and The US Oncology Networkcommended a bipartisan group of 124 lawmakers in the U.S House of Representatives who sent a letter to the Centers for Medicare and Medicaid Services (CMS) expressing concern that Medicare cuts to critical cancer medications, which took effect on April 1, 2013 as part of the budget sequester, are forcing oncologists to turn away cancer patients.

The letter, led by Representatives Pete Sessions (R-TX; photo left), Gene Green (D-TX; photo right), Mike Burgess (R-TX), Allyson Schwartz (D-PA), Ed Whitfield (R-KY) and Ron Kind (D-WI), asks the Centers for Medicare and Medicaid Services to use its authority to apply the 2% sequester cut to only the service payment and not to the cost of chemotherapy drugs and biologic treatments.

Twofold concern
The letter specifically states: “Our concerns are two fold. First, it is unclear to us if the Centers for Medicare and Medicaid Services has the statutory authority to reduce Medicare Part B drug reimbursement since that amount is specified in the [Medicare Modernization Act of 2003 (MMA)]. Second, concerning sequestration, the Office of Management and Budget (OMB) has issued guidance instructing federal agencies and departments to, ‘use any available flexibility to reduce operational risks that minimize impacts on the agency’s core mission in service of the American people…‘ We would like to see CMS use any flexibility that exists to implement the cuts in such a way that the core mission of the agency ? to provide care to beneficiaries ? is retained and protected.”

Emergency mode
The lawmakers cite recent news reports that Medicare beneficiaries seeking cancer care have already experienced access issues to community-based cancer care since the cuts went into effect on April 1, 2013. The sequester cut has sent community cancer clinics into emergency mode, with many clinics now being forced to send certain Medicare patients elsewhere for treatment.

Flawed Medicare payment for cancer drugs has already markedly impacted cancer care delivery and patient access to community-based care. Until recently, more than 80% of the nation’s cancer patients were treated in physicians’ offices in the community setting. Since 2008, more than 1,200 community cancer care centers have closed, consolidated, or reported financial problems. When community cancer clinics close their doors, access to cancer care is compromised for all cancer patients, but especially vulnerable seniors. Studies by Milliman [1] and Avalere [2] document that consolidation of care results in higher costs of cancer treatment for Medicare, seniors, and all taxpayers.

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Questions & Answers
In the letter, the bipartisan lawmakers ask Centers for Medicare and Medicaid Services to answer a series of questions by April 29, 2013 regarding the agency’s flexibility in applying the sequester cut to Medicare Part B drugs as well as plans for monitoring the effect of this cut on Medicare beneficiaries. In closing, they also ask, “…that any available flexibility be used to direct the cuts away from patients. Our hope is that there is a solution that protects patients’ access to their healthcare professionals.”

For more information:
Full letterfrom bipartisan lawmakers

[1] Site of Service Cost Differences for Medicare Patients Receiving Chemotherapy. Milliman, October, 2011. [Download Full Report]
[2] Total Cost of Cancer Care by Site of Service: Physician Office vs Outpatient Hospital. Avalere Health, March, 2012. [Download Full Report]

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