%u25BA POLITICS & POLICY
Bill To Solve Reimbursement Problems Introduced to House of RepresentativesN
ew legislation that addresses solutions to problems with Medicare reimbursement for cancer care has been introduced in the House of Representatives. The legislation—known as the Community Cancer Care Preservation Act of 2007 (HR 1190)—is
being cosponsored by Representatives Artur Davis (D-AL) and Jim Ramstad (R-MN).
Representatives Davis and Ramstad, who both sit on the House Ways and Means Committee, have heard first-hand from practices about the problems with Medicare reimbursement for community cancer care. These members have visited community cancer clinics in their districts, have met with the leadership of the Community Oncology Alliance (COA), and have been very involved in understanding the issues. Mr. Ramstad sponsored legislation addressing this issue in the prior session of Congress.
HR 1190 seeks to address the key problems with drug and services reimbursement, including:
• Elimination of “prompt payment” discounts
from the calculation of average
sales price (ASP) so that ASP is not artifcially
lowered by finance discounts between
manufacturers and wholesalers.
• Removal of the 6-month lag in ASP so
that community cancer clinics are not
unfairly subsidizing the Medicare system
for manufacturer price increases.
There were more than 100 price increases
• Creation of payment codes for essential
components of quality cancer care that
Medicare does not currently reimburse;
specifically, treatment planning and
• Restoration of appropriate payment for
the first hour and subsequent hours of
cancer drug administration.
The use of ASP to determine reimbursement is not without controversy, however. According to the National Association of Chain Drug Stores, using ASP to determine pharmaceutical reimbursement under Medicare Part B, rather than Average Wholesale
Price (AWP), will have a significant negative impact on pharmacies. This negative result will be further magnified and multiplied if other public and private prescription drug programs such as a Medicare outpatient drug benefit, Medicaid, private pharmacy benefit managers (PBMs), insurance companies, the Department of Defense’s Tricare program, and the Federal Employees Health Benefit Program (FEHBP), use ASP rather than their current reimbursement system.
The COA has worked with Representatives Davis and Ramstad and has expressed appreciation for their support for community
cancer care. More details on the bill are expected in the near future. – John D. Zoidis, MDNCI Budget Cuts Affecting Cancer ResearchT
he recent congressional decision on the 2007 budget for the National Cancer Institute (NCI) keeps the budget essentially the same as last year, which means a flat funding for more than two years in a row that is leading to cuts in key cancer research across the country.
In February, Congress approved a continuing resolution that finalized the NCI’s budget at $4.79 billion. This is an increase of $46 million over the 2006 budget, which members of the cancer research community say is an insignificant increase. This is “essentially a cut because in a situation where you have a flat fund over a period of two to three years, inflation begins to take over and so effectively your spending power is less,” Deborah Kamin, senior director for cancer policy and clinical affairs at the American Society of Clinical Oncology (ASCO) told Oncology & Biotechnology News
. “What the cancer research community has done in response is begin to pull back and tighten their belts to live within the budget constraint.”