ASCO recently submitted comments to the Department of Health and Human Services (HHS) in response to a proposed rule that would eliminate protection for manufacturer rebates on prescription drugs in the Medicare and Medicaid programs. The society’s comments express a shared concern over rising prescription drug costs and urge HHS to implement policies that make rebate arrangements transparent, while ensuring that efforts to address the problem don’t inadvertently lead to higher out-of-pocket costs for people with cancer.
ASCO’s comments stress that the final rule should include patient protections that prevent payers from compensating for a potential loss of revenue by increasing premiums or other out-of-pocket costs for patients. Additional out-of-pocket costs could result in some Medicare and Medicaid beneficiaries abandoning their cancer treatment because they are unable to pay for it.
To promote transparency, ASCO supports the provisions in the proposal to ensure that patients are aware of their most cost-effective option for purchasing medications and urges HHS to enforce the Patient Right to Know Drug Prices Act and the Know the Lowest Price Act. Both laws prohibit so-called "gag clauses," which prevent pharmacists from sharing information about the most cost-effective option for purchasing required medications with patients.
The comments also express ASCO’s serious concerns about the utilization management decisions that are tied to rebates and discounts. Tactics such as “fail first,” or step therapy policies, threaten patient lives by delaying or limiting timely access to the most appropriate treatment. ASCO’s comments highlight the need greater for transparency regarding utilization management practices and support the proposed rule’s efforts to achieve clarity in this area.
Read the full comments.
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