Cancer Drug Cost Bill Reintroduced

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The bill, originally introduced in 2013, seeks to terminate sequestration to payments for certain drugs and biologicals.

Not only have sequestration cuts in cancer drug reimbursement under Medicare plans adversely affected physician payments for physician-administered cancer medications, they have also adversely affected patient care, the Community Oncology Alliance declares in a statement released on Mar. 19, 2015. The cuts, which were enacted on Apr. 1, 2013, slashed reimbursement to doctors by 2% based on the cost of cancer drugs. As a result, many community oncology clinics have closed, the organization said. In the statement, the Alliance also announced its support of the reintroduction of the Cancer Patient Protection Act of 2015 (HR 1416).

The bill, spearheaded by Representatives Renee Ellmers (R, NC) and Steve Israel (D, NY), seeks to prevent the Centers for Medicare & Medicaid Services (CMS) from “inappropriately applying the Medicare sequester cut to the underlying payment for cancer drugs and other Part B therapies,” and directs CMS to exempt chemotherapy drugs and other physician-administered drugs from the 2% cuts. Rep. Ellmers said that the bill will help keep Medicare patients out of the hospital setting, where cancer therapies are more expensive. These price hikes typically occur because of specialty drug mark-ups related to drug administration.

While Rep. Ellmers says the legislation “merely directs HHS on how to implement sequestration, and does not change the spending level mandated in the Budget Control Act,” it can effectively save money by directing seniors on Medicare receiving cancer treatment to community sites of care.


According to a report from the American Association of Clinical Oncology (ASCO), "The State of Cancer Care in America," eight of the 10 most expensive drugs reimbursed by Medicare are cancer drugs. ASCO is currently in the process of testing a new payment model for oncology drugs focused on value-based, bundled payments, and it expects to release the results of its pilot program in 2015.

Sources: Community Oncology AllianceCongresswoman Renee Ellers