Reimbursement

A new ASCO survey of U.S. oncology practices shows the automatic two percent budget cut to Medicare chemotherapy drug reimbursement under sequestration is already having a significant impact on care for people with cancer just one month after the federal funding reduction went into effect.

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The House Ways and Means and Energy and Commerce Committees recently requested feedback from ASCO and other medical societies on its second draft of their sustainable growth rate reform proposal. ASCO’s response underscores the importance of physician leadership and testing in the areas of quality measurement and development of new payment models as part of SGR reform.

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ASCO along with the Community Oncology Alliance, ION Solutions and The US Oncology Network commended 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 expressing concern that Medicare cuts to critical cancer medications, which took effect on April 1 as part of the budget sequester.

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Rep. Renee Ellmers (R-NC) has introduced legislation that would reverse the sequester cuts that have led some oncology practices to reconsider accepting Medicare patients. Several reports indicate the reductions from this cut are impacting reimbursement both for services and chemotherapy drugs, effectively decreasing Part B drug reimbursement from ASP+6 percent to ASP+4.3 percent.

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Representatives Pete Sessions (R-Texas) and Gene Green (D-Texas) are asking fellow members of Congress to sign a bipartisan letter that seeks more information from the Centers for Medicare and Medicaid Services (CMS) on the impact of sequestration on chemotherapy drugs.

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This afternoon, President Obama released his proposed budget for fiscal year 2014. Among several cost-cutting measures designed to preserve Medicare solvency is a proposal to reduce reimbursement for life-sustaining cancer drugs. Currently, reimbursement to physicians for “Part B” drugs is based on the average sales price plus a 6 percent payment for services needed to administer chemotherapy in physicians’ offices, where most cancer patients receive their care. The President has proposed to reduce the 6 percent service payment to 3 percent. (The budget proposal appears to apply cuts primarily to physicians, but also mentions rebates that will be required by manufacturers.)

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As the two percent across-the-board reduction in Medicare provider payments takes effect today, ASCO is calling for elimination of the cuts, which will disproportionately reduce payments for critical cancer drugs.

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ASCO has joined others in the oncology community in calling on Congress to reinstate the two percent sequestration cuts to Medicare spending, which will disproportionately reduce payments for critical cancer drugs.

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