Cancer takes an enormous toll everywhere, but particularly here in Connecticut where we are among states with some of the higher cancer incidence rates in the nation. According to the American Cancer Society’s Cancer Statistic Center, 21,700 residents will be diagnosed with some form of the disease this year. Overall, some 43 percent of us will be diagnosed with cancer during our lifetime.
Connecticut residents are doing everything they can to find a cure for cancer both professionally and personally.
For some, that means lacing up their sneakers and participating in charity runs, for others, it means showing up for treatment or work at hospitals, cancer centers, medical offices or biopharmaceutical firms across the state.
However, a new proposal that officials at the Centers for Medicare & Medicaid Services (CMS) are pushing could thwart many of these efforts and result in cancer doctors having to move away from providing patients the most advanced medications.
CMS’s plan could deprive patients of some of the best weapons to fight cancer — and ultimately discourage drug companies in Connecticut and across the nation from investing in future research.
At issue is the system Medicare uses under Part B to reimburse doctors for drugs and other infusion medications administered in their offices and clinics. These include chemotherapy drugs.
While touted as a demonstration by CMS, their proposal not only bypasses Congressional approval but could affect 75 percent of physicians nationwide within a year.
These Part B cuts represent huge hurdles for patients racing against cancer.
Medicare currently reimburses doctors for the average sales price of a drug plus a percentage markup — recently reduced from 6 percent to 4.3 percent — to cover handling, storage, and administration. Many doctors pay more than the average sales price, so this small markup can mean the difference between being able to offer certain treatments to their patients or not.
The last cut in reimbursement rates in 2013 had an adverse effect on patients’ access to treatment. Soon after it took effect, it was being reported nationally that clinics started turning away cancer patients because they couldn’t afford to treat them.
Now, the government wants to cut Medicare reimbursements again. Starting this fall, the proposed formula would reimburse doctors for a drug’s average sales price, reduce the markup to 2.5 percent, and add a flat payment of $16.80. While reimbursements for older medications may actually rise under the new formula, they would plummet for newer medications. Many doctors and clinics would find it all but impossible to cover the cost of these more advanced treatments.
By implementing this plan, CMS will decrease patient access to innovative therapies that represent the latest advances in the treatment of cancer The agency doesn’t seem be considering what’s best for patients.
The results of this demonstration could result in cancer clinics being forced to turn away more Medicare patients and making it virtually impossible for doctors to afford to offer their patients advanced medications.
If Medicare no longer makes if feasible for doctors to use the latest medicines, demand for such treatments would decline. Researchers would lose the economic incentive to develop new treatments. Research cutbacks would rob future patients of drugs that could have saved their lives.
There’s still time left for officials to scrap the demonstration. And for patients’ sakes, they should.
Peter Yu, MD, is Physician-in-Chief and Andrew Salner, MD, is Medical Director at the Hartford HealthCare Cancer Institute at Hartford Hospital.