Changes to Medicare Advantage and Part D Could Hinder Patient Access to Emerging Cancer Treatments

February 5, 2019

In a comment letter to the Centers for Medicare & Medicaid Services (CMS), ASCO urged the agency to protect patient access to necessary cancer care under Medicare Advantage (MA) and Medicare Part D. The comments were submitted in response to proposed changes to MA and Part D aimed at lowering drug prices.

The letter expressed the society’s concerns that some of CMS’ proposed changes would compromise appropriate and timely access to cancer drug treatments for MA and Part D beneficiaries.

“As cancer care evolves and advances continue to increase the proportion of orally administered anticancer drugs, ensuring appropriate access to treatment for Medicare beneficiaries is critical,” said ASCO President Monica M. Bertagnolli, MD, FACS, FASCO, in the letter. “Traditionally, intravenous cancer therapies have been provided and reimbursed by Medicare through the Part B benefit. With the introduction of more orally administered therapies, new challenges arise associated with coverage and reimbursement of cancer treatments under Part D.”

ASCO’s recommendations to CMS to address its concerns include:

  • CMS should maintain current protections for the six protected classes of drugs under Medicare Part D.
  • CMS should consider the use of oncology clinical pathways—not step therapy—to guide the delivery of high-quality cancer care.
  • CMS should require a detailed accounting of direct and indirect remuneration (DIR) claw back fees and prohibit the use of measures and standards that are not specific to oncology to determine performance-related payments for oncology providers and oncology practice-based pharmacies.
  • ASCO supports the idea of an integrated real-time benefits tool to support patient-specific decision-making. Such a tool should include both cost and clinical, evidence-based information to support value-based treatment decisions.

Read the full Letter.

ASCO will continue to work with CMS to implement drug pricing policies that benefit Americans with cancer. Stay tuned to ASCO in Action for updates on this issue and other breaking cancer policy news.