Federal Indecisiveness Belies Significant Changes in Medicaid Policy State by State

Debra Patt, MD, MPH, MBA
Published: Friday, Oct 13, 2017
Debra Patt, MD, MPH, MBA

Debra Patt, MD, MPH, MBA
Today’s healthcare landscape is rapidly evolving, with many trends emerging and policy changes under consideration that have far-reaching implications for cancer care. As a medical oncologist at Texas Oncology, I have been very active in collaborating with ASCO, the Community Oncology Alliance, and The US Oncology Network to heighten awareness of issues that may affect access to quality care for patients with cancer. What follows are a few of the major issues we are closely watching.

Policy Changes and Trends

Healthcare reform

There is strong bipartisan support for better control of escalating drug prices, such as:
  • Attempts to change Medicare reimbursement for both Part B and Part D drugs
  • A growing interest in value-based programs
  • An interest in reference pricing benchmarked to international standards

Additionally, there are targeted efforts to control cancer drugs. Last year, the oncology community successfully fought a proposal from CMS to change Part B drug reimbursement from the legislatively mandated average-salesprice-plus-6% formula to a fixed fee with a smaller percentage of reimbursement. Because some small and rural practices purchase drugs at an above-average price, the reduced reimbursement would have made it financially challenging for them to administer expensive drugs, reducing access to novel treatments for Medicare beneficiaries. There is still much interest in modifying structures of reimbursement, as illustrated by the Medicare Payment Advisory Commission’s interest in a voluntary drug value program or alternative structure of reimbursement for Part B drugs.

340B Incentives

The 340B Drug Pricing Program was initially designed to help hospitals and select community and disease-specific health clinics that care for a disproportionately high share of indigent and low-income patients. The federal program allows 340B-eligible hospitals to purchase drugs at upward of a 50% cost reduction compared with what private-practice oncology centers and others pay.
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