On May 16, the Centers for Medicare & Medicaid Services (CMS) released a final rule on drug coverage policies. After receiving feedback from the American Society of Clinical Oncology (ASCO) and other stakeholders, CMS did not finalize a proposal that would have impeded access to drugs within Medicare Part D’s Six Protected Classes. The agency did, however, finalize a proposal to allow the use of step therapy for protected class prescription drugs under Medicare Advantage and Part B—despite stakeholder concerns.
ASCO in Action regularly provides the latest news and analysis related to cancer policy news; see the following online articles. These updates provide snapshots of ASCO’s ongoing advocacy efforts, as well as opportunities for ASCO members and guests to take action on critical issues affecting the cancer community.
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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.
ASCO recently submitted comments to the Senate Finance Committee hearing, “Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead.” The society’s comments focus on ASCO’s efforts to help members implement provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) in their practices and offered ideas for how Congress and the Centers for Medicare & Medicaid Services (CMS) can strengthen MACRA and the Medicare program in the years ahead.
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.
This is the first year that Quality Payment Program performance information will be publicly reported, and many stakeholders asked the Centers for Medicare & Medicaid Services (CMS) for additional time to review their data before it becomes available to the public. Therefore, CMS is offering a supplemental Physician Compare preview period. All eligible clinicians and groups should check their performance information by logging into the Quality Payment Program website.
"We strongly oppose the White House budget proposal for Fiscal Year (FY) 2020, which would stall our nation’s progress against cancer and impede access to needed care for the millions of Americans dealing with cancer. The proposal would make drastic, unprecedented cuts to the U.S. Department of Health and Human Services—which houses the National Institutes of Health (NIH), the National Cancer Institute (NCI), and the Centers for Medicare & Medicaid Services (CMS)."
In late January, ASCO notified members that some oncology practices and providers in the Merit-Based Incentive Payment System (MIPS) received inaccurate 2019 payment adjustments as a result of Medicare Part B drug costs incorrectly being included in the adjustments. CMS is now working to correct the payments. ASCO is in contact with the agency and will keep members informed as a solution is implemented. No action is required from MIPS participants at this time.
On February 12, 2019, ASCO leadership and members of the society’s Government Relations Committee met with representatives from key federal agencies, advisory groups, and other stakeholder organizations to discuss top cancer policy priorities. The meetings focused on access to clinical trials, drug pricing, step therapy, drug shortages, Medicaid waivers and other issues affecting people with cancer.
On January 31, ASCO joined more than 60 organizations in requesting the Centers for Medicare & Medicaid Services (CMS) to reverse its recent decision to limit coverage for Next Generation Sequencing (NGS). The organizations expressed concern that the decision will make it harder for patients to access medically necessary and relevant clinical tests, reducing the quality of their cancer treatment and care.
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.
ASCO has been informed that some oncology practices and providers in the Merit-Based Incentive Payment System (MIPS) have received inaccurate payment adjustments as a result of Medicare Part B drug costs incorrectly being included in the adjustments.
In a comment letter to the Centers for Medicare & Medicaid Services (CMS), ASCO urged the agency to ensure that every Medicaid enrollee with cancer can access the high-quality care needed to treat their disease. The comments were submitted in response to a proposed rule on Medicaid and the Children’s Health Insurance Plan (CHIP) Managed Care that aims to streamline the programs’ regulatory requirements, reduce administrative burden, and increase flexibility for state governments.
ASCO congratulates Anand Shah, MD, MPH, on being named Senior Medical Advisor for Innovation at the Centers for Medicare & Medicaid Services (CMS). In his new role, Dr. Shah will lead efforts across CMS to advance medical innovation reporting directly to CMS Administrator Seema Verma.
Reimbursement cuts for certain oncology specialties. Changes in documentation requirements for certain E&M services. Reduced reimbursement for new Medicare Part B drugs. These are some of the changes coming to the Medicare Physician Fee Schedule and the Quality Payment Program this year. In the latest ASCO in Action Podcast, ASCO CEO Dr. Clifford A. Hudis discusses the changes made to the physician fee schedule and the Quality Payment Program, and what this may mean for your oncology practice.