Cancer Care Advocates Urge Congress to Stop Sequester Cut to Cancer Drugs

WASHINGTON, May 7, 2014 /PRNewswire-USNewswire/ -- Physicians and cancer care professionals from across the country are asking lawmakers in Congress this week to stop the Centers for Medicare and Medicaid Services (CMS) from applying the sequester cut to Medicare payments for cancer care drugs as part of a "Virtual Hill Day" supported by The US Oncology Network and the Community Oncology Alliance (COA).

Community cancer care advocates are asking lawmakers in the U.S. House of Representatives to help stop the sequester cut to cancer drugs by co-sponsoring The Cancer Patient Protection Act (H.R. 1416), which instructs CMS to stop applying the 2 percent sequester cut to payments for Medicare Part B drugs, including cancer drugs and therapies.  The bipartisan bill, introduced by Congresswoman Renee Ellmers (NC-2), currently has 110 cosponsors.

"Cancer patients and their care teams are witnessing the direct impact of the sequester on the delivery of community cancer care and it is time that lawmakers hear this directly from their constituents – and take action." said Barry Brooks, MD, chairman of the Pharmacy & Therapeutics Committee for The US Oncology Network. "Since the sequestration cut took effect more than a year ago, I have seen practices close, clinics merge with larger healthcare systems and patients turned away to seek care in the hospital setting. Cancer patients and oncologists have been hit hardest by the sequester because of the perverse way the cuts have been applied to the anticancer medications we provide in our offices."

The impact of the sequester cut on community cancer care providers is compounded by the fact that sequestration cuts are being applied to the drugs as well as the services provided in cancer clinics. Medicare reimbursements for cancer drugs are specifically fixed by law at average sales price (ASP) + 6%, as opposed to services or budgets cut by sequestration.  Community cancer clinics are at a unique disadvantage when compared to other provider groups because this cut has an impact well beyond 2 percent.  The reduction of the 6 percent add-on to ASP is effectively reduced to 4.3 percent after the sequestration is applied, which results in a total cut of 28 percent.

Cancer care advocates are also emphasizing that the community cancer care delivery system is already under extreme stress.  Since 2008, more than 1,300 community cancer care centers have closed, consolidated, or reported financial problems, therefore reducing patient access to cost-effective community care and forcing patients to seek care in costlier hospital outpatient departments.

Research demonstrates that the migration of physicians from small, community practices to hospital employment is resulting in dramatically higher cancer spending in the U.S.  A study released earlier this week from the IMS Institute for Healthcare Informatics found that cancer drug spending has increased significantly in the last two years as more physicians are providing care in hospital outpatient clinics instead of low-cost community cancer clinics.  The report states, "The U.S. has exhibited steady growth in the number of oncologists over the past decade although smaller physician practices have merged into larger ones or closed down completely, often driven by financial pressures felt by the oncologists."

Data show that community cancer care can be delivered at a much lower cost to patients and Medicare than cancer care delivered in other settings.  The September 2013 study from the Moran Company found significantly higher costs to the Medicare program for patients receiving chemotherapy treatment in hospital outpatient departments versus physician community cancer clinics. The report also revealed that Medicare cancer patients receive more chemotherapy treatments with more expensive chemotherapy drugs in hospital outpatient departments compared to physician-run clinics resulting in chemotherapy costs that are higher by as much as 47 percent. 

Earlier studies by Avalere and Milliman indicate that cancer center closures and consolidations result in higher cancer treatment costs to Medicare, seniors and taxpayers. Hospital-based cancer care costs Medicare approximately $6,500 more and seniors $650 more annually.

"Because more than 60 percent of cancer patients in the U.S. rely on Medicare to pay for their cancer care, it is essential that policies support the delivery of care in more cost-effective community cancer clinics, or else Medicare payment policies will continue to drive up the cost of care," stated Ted Okon, Executive Director, Community Oncology Alliance (COA). "At a time when the nation is desperately looking for ways to cut healthcare spending, Medicare policies for cancer care continue to directly contradict this goal while simultaneously putting patient-preferred cancer care at risk."  

Added Okon, "The Administration has exempted portions of the Affordable Care Act from sequestration, so CMS can certainly stop the sequester cut to cancer drugs.  We are simply asking for fairness and consistency in applying the same policy to the sequester cuts to cancer care."

SOURCE Community Oncology Alliance; The US Oncology Network