ASCO’s Interim Executive Vice President and CEO, Joseph S. Bailes, MD, testified at a hearing held by the House Ways and Means Subcommittee on Health, on issues related to Medicare payment for Part B drugs and services. The subcommittee’s hearing focused on the implementation of the average sales price (ASP) payments for cancer drug reimbursement and sought input on the effects of this new payment system on cancer care.

ASCO thanks Health Subcommittee Chairwoman Nancy Johnson (R-CT) for convening the hearing. Subcommittee members expressed concern about how deficiencies in the Medicare reimbursement system may affect access to care for cancer patients, particularly for patients in rural areas and patients who do not have supplemental insurance.

ASCO testified that many ASCO members are experiencing a shortfall in Medicare payment for some drugs. ASCO also highlighted the need for increased payments for cancer care services. Dr. Bailes also encouraged Congress to continue to work with ASCO and the cancer care community to develop approaches to overcoming shortcomings in the current system, in order to ensure that patient care is not disrupted.

ASCO’s recommendations to the Committee include:

• Allow for appropriate reimbursement for chemotherapy drugs
  ASCO noted that the Medicare statute is unbalanced, since it allows CMS to lower the ASP payment rate when it exceeds the widely available market price, but does not permit raising the ASP payment rate when it is less than the price most practices are paying. To avoid potential access problems for patients, ASCO reiterated its support for H.R. 5179, introduced by Rep. Ralph Hall (R-TX), which would create a floor for Medicare payments and would exclude prompt pay discounts to wholesalers and distributors from the ASP calculation. 
  
• Improve reimbursement for chemotherapy services
  Dr. Bailes testified that Medicare payments do not cover the cost of providing all of the services required for comprehensive cancer care, and further legislative changes are needed to provide these critical patient services. ASCO reiterated its support for legislation that provides appropriate reimbursement for development of a comprehensive cancer care plan. In addition, ASCO stated that CMS must revise the manner in which it is calculating the practice expenses associated with particular services because it is not currently adequate.
  
• Support a multi-year extension of the CMS oncology demonstration project
  ASCO told the Committee that the oncology demonstration projects administered by CMS in 2005 and 2006 provided resources that enabled oncology practices to continue to provide high quality cancer care to their patients. ASCO urged the Committee to support a multi-year extension of the demonstration project, so enough data to support well informed quality enhancement initiatives could be collected.  
  
• Change patient coinsurance requirements
  ASCO noted that the 20% coinsurance payment for cancer drugs can be an unreasonable burden on patients and contributes to practices’ bad debt. ASCO recommended that Congress reduce or eliminate the patient burden of coinsurance for Part B drugs.

Representatives from Medicare, other federal government bodies, and provider and patient groups also testified at the hearing. ASCO will continue to work with those in the cancer care community and on Capitol Hill who support long-term, sustainable change to the Medicare system to improve the quality of cancer care for all patients on Medicare.

ASCO’s testimony is available on ASCO.org. If you have any questions, contact ASCO’s Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.