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Medicare Proposals Threaten Access to Care
By Greg Brozeit

It is important for all cancer advocates to follow the actions of the conference committee closely over the next two weeks and let their senators and representatives know of their opposition to any cancer cuts in the proposed Medicare Prescription Drug Benefit legislation. (Three sample letters to Congress are available as PDF files.)

The Bush administration and Congress have agreed to fund a Medicare Prescription Drug Benefit with $400 billion over the next ten years. Many knowledgeable observers have estimated that the actual cost of a comprehensive drug benefit would actually cost $2 trillion over the same period.

Reimbursements for higher priced drugs and therapies, especially those for cancer, are being targeted in order to find cost savings to provide a benefit within the parameters of $400 billion.

The House and Senate made respective cuts of $13 billion and $16 billion in the formulas for Medicare reimbursements to oncologists over the next ten years in the bills they passed earlier this year. It is estimated that if the conferees agree on either of those funding levels, it would take as much as $500 million out of the current reimbursement system as early as next year.

Sen. Arlen Specter (R-PA), chairman of the Senate Labor, HHS, and Education Appropriations Subcommittee and arguably the strongest support of cancer issues in Congress, wrote to Senate Majority Leader Bill Frist (R-TN) and Senate Finance Committee chairman Charles Grassley (R-IA) expressing his concerns.

According to the letter, "[the Senate bill] contains a provision which would reduce the reimbursement of oncological drugs from 95 percent of the average wholesale price to 85 percent of the average wholesale price...his cut may force oncology clinics and physicians to reduce staff, close satellite offices in rural areas, or reduce the number of Medicare patients they treat, thereby gravely impacting the quality of care for beneficiaries."

Sen. Specter reminded Sens. Frist and Grassley In a hand-written postscript to the letter that "this poses a real squeeze to cancer care."

More ominously, CMS Administrator Tim Scully published proposed rules in the October Federal Register that would be even more draconian than the proposals being considered in Congress. If Congress were to conclude its business this year without passing the Medicare reform bill, those rules could be implemented early next year.

One of three of the following scenarios will likely have to be accepted by the cancer community:

  • Congress could pass a Medicare reform bill that would maintain the current reimbursement system by finding savings in other areas under consideration.
  • Congress could pass a Medicare reform bill that would cut reimbursements for oncology drugs by $13-16 billion over the next ten years.
  • Congress may not act on a Medicare reform bill at all prior to a targeted mid- to late-November adjournment, thus setting the course for the implementation of the CMS proposed rules.

Only the first scenario is acceptable to cancer patients.

Should the CMS rules go into effect, Congress could use a little used law to block them from going into effect. It would be similar to the process by which Congress voted earlier this year to block the Federal Communications Commission from altering media ownership rules.

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