The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining a demonstration project that would reduce the Average Sales Price (ASP) reimbursement rate based on primary care service areas (by zip codes). This ruling has sparked widespread concerns over its singular focus on drug costs, costs that oncologists do not—and cannot—control. ASCO has responded assertively in opposition of the mandatory five-year Part B Drug Payment proposal. ASCO will maintain pressure on CMS to withdraw the proposal and focus on real reform that cuts costs and enhances care, while protecting the health and safety of Medicare patients who rely on Medicare Part B drugs.
Although we agree that the current Medicare payment system is fundamentally flawed, ASCO opposes reforms that are not comprehensiv. Therefore, ASCO urges CMS to withdraw an experiment of this magnitude without first understanding its potential impact on patient care. We are particularly alarmed at the proposal’s failure to describe patient protections, including mechanisms to avoid adverse consequences of mandating nationwide participation.
The CMS proposal is particularly ill-suited to the delivery and treatment of cancer care, which is complex and highly personalized to each patient, and offers limited opportunity for a physician to choose between two interchangeable, equally efficacious drugs—the very scenario under which the demo seeks to influence physician prescribing behavior. This experiment will not address individual drug prices—as physicians do not set these prices—and will hinder patient-centered care and access to services.
Finally, the Part B Model ignores promising work that has the potential to yield comprehensive reforms and achieve CMS’s stated goals. ASCO has labored for more than a decade to support oncology practices in the delivery of high-quality, high-value oncology care, including its Patient-Centered Oncology Payment model, Clinical Oncology Pathways statement, CancerLinQ, Quality Oncology Practice Initiative (QOPI), and the ASCO Value Framework .
We believe this work can provide the seeds of a comprehensive healthcare delivery and payment system that will support high-quality, high-value oncology for all individuals facing life-threatening cancers. ASCO looks forward to working closely with CMS and other stakeholders to address the complex issues involved in transforming cancer care in the United States.
ASCO's specific efforts opposing the demo include:
- Drafting letters urging CMS and Congress to withdraw the demo
- Speaking out against the demo in the media--ASCO representatives were quoted in MedPage Today, Modern Healthcare, The New York Times, Politico, The Wall Street Journal, and other media outlets
- Submitting an ASCO in Action op-ed that was published in Diagnosis: Cancer--a new blog from the Philadelphia Inquirer and Philly.com
- Supporting legislation in the House of Representatives to prohibit the demo
- Submitting formal comments to CMS outlining the society's objections to the demo
- Encouraging ASCO members to contact their Congressional representatives to gather support for House and Senate letters to CMS asking the Agency to pull the demo (in the House letter alone, nearly 250 lawmakers called on CMS to withdraw the proposal)
- Voicing the oncology community's opposition to the proposal on Capitol Hill before the Health Subcommittee of the House Energy and Commerce Committee
ASCO will monitor and continue its robust advocacy work on Capitol Hill. Individuals may take action by contacting their elected officials through ASCO's ACT Network to express opposition to the demo (to date, ASCO members have sent more than 1,900 messages to Capitol Hill regarding the proposal).
Stay tuned to ASCO in Action for the latest on the proposed Part B demonstration project.