President’s Budget Proposes Changes to Physician Reimbursement

February 15, 2018

On February 12, the White House released its Fiscal Year (FY) 2019 budget proposal, which included several provisions and budget changes of interest to the cancer community. While the proposal is not binding, it does provide a view into some of the Administration’s goals and budget priorities for the year.

Physician Reimbursement

While details of the proposed budget are limited, ASCO has concerns over provisions that would reduce reimbursement for new drugs from Wholesale Acquisition Cost (WAC) +6 percent to WAC +3 percent and consolidate Medicare Part B drugs into the Part D program. The society is concerned such changes could result in a major cut to physician reimbursement for Part B drugs, making it increasingly difficult for oncologists to cover essential patient services. We ask Congress to reject any such proposals and protect patient access to cancer care.

In addition, the budget proposes changes to the Quality Payment Program by eliminating “low-value metrics” in the Merit-based Incentive Payment System (MIPS), assessing clinician performance on the group level only, and changing incentives to encourage more practices to participate in alternative payment models. ASCO is evaluating these proposals and will continue to work with Congress and the Administration on any changes to physician reimbursement.

Access to Cancer Care: Medicaid Proposal

The President’s budget includes a proposal that would repeal Medicaid expansion and transition federal funding for the Medicaid program to block grants. These proposed changes do not meet ASCO’s principles for healthcare reform and would jeopardize access to cancer care for some of the most disadvantaged Americans.

Funding for Federal Agencies

The proposal includes a very modest increase from the current funding level for the National Institutes of Health (NIH)— due primarily to consolidation of other research agencies, including the Agency for Healthcare Research and Quality (AHRQ), within the NIH. ASCO believes funding stronger investment in the NIH and NCI is needed to make up for years of stagnant funding and calls on Congress to continue their work towards bipartisan and sustained funding increases to support biomedical research in the United States.

However, ASCO is pleased that the proposal calls for more than $20 million in funding for the Oncology Center for Excellence (OCE) to support its mission within the Food and Drug Administration (FDA).


The budget proposal calls for changes to the 340B Drug Pricing Program by reducing payments to hospitals that provide little or no charity care. In addition, hospitals would have to report how they use the savings from the 340B program. ASCO continues to monitor and weigh in on various proposals to reform the 340B program within the Administration and Congress to ensure they adhere to the recommendations outlined in ASCO’s 340B statement.

ASCO is continuing to review the budget proposal and will provide additional updates on ASCO in Action