Effective January 1, 2019, Medicare is instituting new opioid prescribing policies that will impact Medicare Part D beneficiaries with a prescription drug benefit and their prescribers. Major changes are summarized below; for additional information please see the full Medicare Learning Network article.
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.
To sign up for advocacy alerts, log in to ASCO.org with your ASCO member or guest account, and visit the subscription center available under your account profile.
Update: ASCO’s resolutions on step therapy, Medicare Part B drugs, a Competitive Acquisition Program (CAP), and clinical trial access were adopted or reaffirmed by the American Medical Association (AMA) House of Delegates, as well as an ASCO-backed resolution on Qualified Clinical Data Registries (QCDRs).
Leaders from the ASCO State Affiliate Council met to discuss pressing issues in oncology, including drug pricing, Medicaid work requirements, changes to the Medicare physician fee schedule, and the role of pharmacy benefit managers (PBMs).
The Centers for Medicare & Medicaid Services (CMS) released the final rule for the Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) outlining reimbursement changes for 2019. CMS estimates that the overall impact will be a one percent reimbursement cut for the hematology/oncology and radiation/oncology specialties in 2019. Based on feedback from ASCO, significant changes were made, which helped to avoid an overall four percent reduction for the specialty. However, it is important to note that the actual impact on individual physician practices will depend on the mix of services the practice provides.
The Centers for Medicare & Medicaid Services (CMS) released its 2019 Hospital Outpatient Prospective Payment System (HOPPS) final rule. An initial evaluation of the rule found that CMS finalized provisions cutting Medicare reimbursement for certain visits to hospital outpatient clinics and to extend 2018 cuts to the 340B Drug Pricing Program.
On October 25, 2018, CMS released the International Pricing Index Model for Medicare Part B Drugs, an advanced notice of a proposed rule that, if implemented, would establish a pilot program to test ways to lower the costs of drugs. Provisions in the proposal include benchmarking some part B drug prices against other countries and changing how providers get paid for administering drugs to patients. The proposal marks the most sweeping changes the Administration has put forth to implement the President Trump’s “blueprint to lower drug prices and reduce out-of-pocket costs.”
A bipartisan group of more than 100 members of the U.S. House of Representatives signed a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma urging the Agency to review and improve prior authorization practices under Medicare Advantage (MA). The letter, led by Rep. Ami Bera, MD (CA-7), and Rep. Phil Roe, MD (TN-1), cites concerns that MA beneficiaries may be encountering barriers to care due to “onerous and often unnecessary prior authorization requirements.”
The Center for Medicare & Medicaid Services (CMS) has released performance feedback for Merit-based Incentive Payment System (MIPS) clinicians who participated the 2017 performance year. Individual clinicians, groups, and eligible clinicians in certain Alternative Payment Models (APMs) can access a comprehensive overview of their MIPS final score, performance category details, and 2019 MIPS payment adjustment on the Quality Payment Program (QPP) website.
The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen LLC, are field testing 13 cost measures before consideration of their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program in 2020 or beyond.
In a comment letter to the Centers for Medicare & Medicaid Services (CMS) ASCO expressed significant concerns that provisions in the 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule would undermine Medicare beneficiary access to cancer care due to reimbursement cuts based on site-of-service that fail to address systemic payment deficiencies for cancer care services under Medicare. ASCO urges CMS to forego implementing any additional utilization management strategies and instead enhance patient access to cancer care by facilitating participation in Advanced Alternative Payment Models (APMs) that use oncology clinical pathways to promote high-quality cancer care.
In the latest ASCO in Action Podcast, Manali Patel, MD, MPH, joined ASCO CEO Dr. Clifford A. Hudis to discuss ASCO’s position statement on Medicaid work requirements, which addresses state waivers submitted to the Centers for Medicare & Medicaid Services (CMS) that, if approved, would make Medicaid eligibility, continued coverage, cost-sharing, and other program benefits dependent on a beneficiary’s work status.
ASCO recently hosted a webinar offering an overview of the 2019 Medicare Physician Fee Schedule and Quality Payment Program proposed rule and its potential impact on individuals with cancer. ASCO strongly opposes aspects of the proposed rule that could significantly cut cancer care resources needed to provide high-quality care, and the society urges the Centers for Medicare & Medicaid Services (CMS) to abandon the proposal. ASCO members can still watch this important webinar and view the slides from the presentation.
The American Society of Clinical Oncology (ASCO) today issued a set of recommendations for overcoming financial barriers to patient participation in cancer clinical trials. ASCO’s policy statement, “Addressing Financial Barriers to Patient Participation in Clinical Trials,” stresses the importance of increasing participation in clinical research, especially for patients from particular ethnic/racial, geographic, age, socioeconomic, and other underserved demographic subgroups.
The American Society of Clinical Oncology (ASCO) warns that Medicaid work requirements may hinder patients’ access to essential cancer care and reduce the already limited time physicians are able to spend with their patients. In a new position statement released today, ASCO also recommends that federal and state policymakers take specific steps to ensure that new Medicaid requirements will not harm patients with cancer.
ASCO strongly opposes the Centers for Medicare & Medicaid Services (CMS) decision to allow Medicare Advantage plans to employ step therapy across physician-administered and self-administered drugs under Medicare Part B and Part D.