Senate Bill To Protect Patients' Healthcare By Amending Medicare Coverage

Main Category: Medicare / Medicaid / SCHIP
Article Date: 12 Jun 2009 - 6:00 PDT

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The U.S. Senate has introduced a bill, S. 1221, "The Medicare Prompt Pay Correction Act," a companion bill to H.R. 1392, which was introduced in the U.S. House of Representatives and currently has 45 co-sponsors.

The Senate bill was introduced by Senators Arlen Specter (D-PA) and Pat Roberts (R-KS). The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs and in alleviating a national problem affecting the delivery of cancer care treatment to patients, almost all of whom are treated in community oncology clinics close to their homes.

"Community cancer clinics play a critical role in our nation's fight against cancer, especially in rural areas where families do not have access to larger centers," said U.S. Senator Arlen Specter (D-PA). "I am pleased to introduce this legislation which will help ensure access for Medicare beneficiaries' to potentially life-saving cancer treatments."

This bill will amend title XVIII of the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program. It excludes customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). These discounts artificially reduce Medicare Part B drug reimbursement rates for community oncology clinics, jeopardizing the viability of these providers and thus endangering patient access to affordable, quality cancer care in their communities.

Excluding distributor prompt pay discounts from the ASP methodology is consistent with existing policy and will create greater uniformity among federal healthcare programs. The Medicaid Average Manufacturer Price (AMP) methodology already excludes these terms.

This legislation is an effort to improve the delivery of cancer care treatment to patients. Cancer care must be understood as different from general healthcare in that it is catastrophic in its threat to life, its potency of treatment and its cost. The cancer care delivery system is now in first-stage crisis because Medicare has substantially cut payment for cancer drugs and essential services.

Almost all Americans are currently treated in community cancer clinics, many of which have had to cut staff and close satellite facilities.

Patients with insufficient or no insurance, especially seniors and the swelling ranks of the unemployed, are increasingly being sent elsewhere for treatment and some patients are actually foregoing treatment.

"Especially during these tough economic times, millions of patients should not have to opt-out of quality cancer treatment because they can't afford it," said U.S. Senator Pat Roberts (R-KS).

The problem not only centers on payments for cancer drugs, but also on essential services provided to cancer patients, such as treatment planning, which are not reimbursed by Medicare.

The Community Oncology Alliance (COA) has aggressively advocated for the prompt pay solution.

"We appreciate the leadership of Senator Specter, who has long supported cancer care funding issues, and Senator Roberts for cosponsoring this important legislation," said Patrick Cobb, M.D., president of the Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana.

"This bipartisan bill is a welcomed and needed first step in supporting community cancer clinics," he continued. "The passage of these congressional bills will enable community oncology clinics to continue providing patients with cancer care treatments currently not properly reimbursed by Medicare."

About Community Oncology Alliance (COA)

COA is a non-profit organization dedicated solely to community oncology. COA was founded by community oncology to advocate for patients and providers in the community oncology setting, where 84 percent of Americans with cancer are treated. In only six years of existence, COA has mobilized community oncology to become more politically active, and increased awareness on Capitol Hill about the community cancer care delivery system. Additionally, COA has brought together community oncology practices from across the country to share information in order to enhance the effectiveness and efficiency of the cancer care they provide to their patients.

Currently, COA is working with the Congress in proving proactive solutions designed to protect the viability of the nation's cancer care delivery system and patients' access to quality, affordable cancer care. The cancer death rate in the U.S. has declined due to earlier detection, the quality of treatment, and the accessibility of cancer care. However, according to the American Cancer Society, men still have an approximately one in two lifetime risk of developing cancer, with a risk of one in three for women.

Source: Community Oncology Alliance