The White House’s fiscal year (FY) 2014 budget proposal includes a variety of what it is calling “manageable” changes for Medicare’s 54 million beneficiaries as well as for hospitals, physicians, and other health care providers. One of these changes is a proposal to reduce cancer drug reimbursement from average sales price (ASP) plus 6 percent down to ASP plus 3 percent, a policy the White House estimates will save the federal government $3.3 billion over the next 10 years. Patient advocacy and provider groups as well as industry are calling foul.
Ted Okon of the Community Oncology Alliance pointed out the proposal would exacerbate the 2 percent sequestration cuts already impacting cancer clinics with even steeper cuts to physician-administered drugs. Okon said he is “appalled” by the proposal though not surprised it appeared in the budget considering the “little sympathy” the Administration has shown to cancer clinics.
The Biotechnology Industry Organization (BIO) also raised deep concerns with the President’s proposal to reduce physician reimbursement for Medicare Part B drugs, saying the cuts would threaten patient access to important therapies. “Within the past week we have seen news reports detailing how patients are seeing their access to these therapies limited due to sequestration-related cuts in this area,” BIO CEO Jim Greenwood stated in a release. According to Greenwood, lowering the reimbursement rate even further will make this situation much worse.
The Washington Post recently reported oncologists were already turning away cancer patients due to the sequestration cuts. According to Okon, the 2 percent sequestration reduction affects 80 percent of a claim for which Medicare is responsible. “When you factor in the changes in the proposed budget, the Administration is effectively double-dipping,” Okon said. He also questioned CMS’ legal authority to adjust a congressionally-mandated reimbursement formula.
President Obama’s budget plan is far from the last word. House Republicans have approved their own FY 2014 budget blueprint, as have Senate Democrats. Notably, many of Obama’s Medicare proposals have been included in prior budget proposals that were ultimately not approved by Congress.
GIRS has several years of experience advocating for the coding, payer coverage and appropriate reimbursement for cancer drugs. Please call 901-754-2827 for further assistance.