CMS Final Rule Maintains Protections for Part D Beneficiaries with Cancer; Safeguards Still Needed Under Medicare Advantage and Part B

Statement by Monica M. Bertagnolli, MD, FACS, FASCO, President of the American Society of Clinical Oncology (ASCO)
May 17, 2019

“The American Society of Clinical Oncology (ASCO) applauds the Centers for Medicare & Medicaid Services (CMS) for listening to ASCO and other stakeholders by not finalizing a proposal that would have significantly impacted access to drugs within the Six Protected Classes. The CMS final rule effectively maintains many of the protections for Medicare beneficiaries with cancer and other chronic illnesses under Medicare Part D. While we support efforts to control drug prices, optimal cancer care requires patient access to the most medically appropriate drug, at the most opportune time, based on the highest quality evidence.

“We are disappointed, however, that CMS finalized its proposal to allow the use of step therapy for protected class prescription drugs under Medicare Advantage and Medicare Part B. Step therapy requires patients to try and fail to have a desired clinical outcome on a lower cost medication before they can access the medication prescribed by their health care provider. This not only delays patient access to proper treatments, it potentially leads to irreversible disease progression and other significant patient health risks.

“ASCO is dedicated to working with policymakers to lower the cost of prescription drugs and strengthen the nation’s healthcare delivery system, but we must also preserve access to high-quality care for all Americans with cancer. We look forward to working with the Administration on a solution for rising cancer care costs that does not put Medicare beneficiaries at risk.”