Senate Bill Introduced to Correct Medicare Drug Reimbursement

WASHINGTON, May 5, 2011 /PRNewswire/ -- U.S. Senator Pat Roberts (R-KS) and lead co-sponsor U.S. Senator Debbie Stabenow (D-MI) have introduced S. 733, a bipartisan bill designed to address a Medicare reimbursement flaw.

The bill proposes to amend title XVIII of the Social Security Act to ensure more appropriate payment for drugs and biologicals under Part B of the Medicare Program by excluding customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). 

Currently, the ASP methodology used to calculate Medicare Part B reimbursement artificially reduces payment for cancer drugs to community oncology practices. This often results in a reimbursement that is insufficient to cover the cancer drug purchase cost, forcing practices to pay out of pocket for treating cancer patients with chemotherapy.

"Affordable and accessible care for cancer patients is critical, and impossible without our nation's system of community oncology practices," said bill sponsor Senator Pat Roberts (R-KS).  "A major component of the survival of community oncology is fair pricing for the chemotherapy drugs purchased on behalf of those patients.  This bipartisan bill is designed to do just that, by providing reasonable reimbursement for doctors who are spending millions of dollars each month in chemotherapy drug outlays for their patients."

Excluding distributor prompt pay discounts from the ASP methodology 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.

"Fair drug pricing affects the financial survival of those providing care to the majority of cancer patients in this country, and this bill provides a much-needed reimbursement solution." said Senator Debbie Stabenow (D-MI). "Without it, those practices will be jeopardized.  If those providing cancer care are threatened, so are their patients.  That is unacceptable."

"The Community Oncology Alliance strongly endorses this bipartisan Senate effort to support cancer care, as well as the companion bill recently introduced in the House of Representatives.  Together, these bills provide a long-awaited solution to a major inequity threatening the survival of community oncology practices," said David Eagle, M.D., president of the Community Oncology Alliance (COA) and partner in Lake Norman Oncology, Mooresville, North Carolina.  

The U.S. has the best cancer care delivery system in the world, in which 84 percent of Americans receive quality, compassionate care in the community cancer setting. However, the cancer care delivery system is suffering because of substantial Medicare cuts to payment for cancer drugs and essential services. The crisis will deepen as demand for cancer care is now starting to exceed the supply of oncologists.  It is predicted that over the next 10 years there will be an oncologist shortage for one in every four cancer patients.

About Community Oncology Alliance (COA)

Formed in 2003 in response to the Medicare Modernization Act, COA is a non-profit organization dedicated solely to community oncology.  COA was founded by community oncologists to advocate for patients and providers in the community oncology setting, where four out of five Americans with cancer are treated.

Currently, COA is working with the Congress in providing proactive solutions designed to protect the viability of the nation's cancer care delivery system and patients' access to quality, affordable cancer care.  The cancer death rate in the U.S. has declined due to earlier detection, the quality of treatment, and the accessibility of cancer care.  However, according to the American Cancer Society, men still have an approximately one in two lifetime risk of developing cancer, with a risk of one in three for women. For more information, please visit www.communityoncology.org.

SOURCE Community Oncology Alliance