Most disconcerting about the President's proposed budget cut to cancer drugs, is that the Administration has already chosen to cut payment by applying the Medicare sequester cut to the underlying cost of cancer drugs. The Centers for Medicare & Medicaid Services (CMS) has questionable statutory authority to cut the Medicare reimbursement rate specifically fixed in law and has ignored flexibility guidance by the Office of Management and Budget (OMB) in implementing sequestration. As a result, as of April 1, 2013, CMS is paying for cancer drugs at the rate of ASP plus 4.3 percent.
The unnecessary sequester cut to cancer drugs is already having an impact on the cancer care of seniors. It has forced community cancer clinics into emergency mode, with many clinics now being forced to send certain Medicare patients elsewhere for treatment. This will increase in scope and severity as the full impact of the sequester cut is realized. It is disconcerting that the Administration is ignoring this crisis, and now threatens to accelerate it with a proposed deeper payment cut to cancer drugs.
Flawed Medicare payment for cancer drugs has already markedly consolidated cancer care delivery. Until recently, more than 80 percent of the nation's cancer patients were treated in physicians' offices in the community setting. Since 2008, more than 1,200 community cancer care centers have closed, consolidated, or reported financial problems. When community cancer clinics close their doors, access to cancer care is compromised for all cancer patients, but especially vulnerable seniors. Studies by Milliman and Avalere document that consolidation of care results in higher costs of cancer treatment for Medicare, seniors, and all taxpayers.
We are also concerned that the President's budget could severely impede the essential cancer-fighting services provided by integrated community cancer clinics. The Administration has proposed significant limitations on the ability of oncologists to order follow-up positron emission tomography (PET) scans for cancer treatment management and planning. Prior payment cuts to advanced imaging services, as well as therapeutic radiation, have further pressured integrated community cancer clinics, potentially eroding effective delivery and coordination of integrated care to Medicare seniors. This is counter to the President's expressed goals for health reform.