CMS Reimbursement Cuts to Cancer Centers Threaten Access to Lifesaving Cancer Treatments for Underserved Patients

Willman

Cheryl L. Willman, MD

On January 1, 2018, the Centers for Medicare & Medicaid Services (CMS) implemented a new rule that significantly reduces reimbursement to hospitals and the vast majority of cancer centers that participate in the Congressionally-mandated 340B Drug Purchasing Program. The new CMS rule (82 FR 52356) went into effect without Congressional approval and despite strong bipartisan objections from legislators in both chambers of Congress, the Association of American Cancer Institutes (AACI), and a large majority of cancer center directors from NCI-designated and emerging academic cancer centers. The rule disproportionately harms those hospitals and cancer centers that provide care for the most vulnerable and underserved cancer patients, compounding the nation’s tremendous cancer health disparities.

Established by Congress in 1992 with strong bipartisan support, the 340B Drug Pricing Program requires drug manufacturers to sell drugs at discounted prices to hospitals and cancer centers that provide a disproportionate share of care to low-income, rural, poor, and underserved patients, to have their drugs covered by Medicare and Medicaid. The Congressional intent of the 340B Drug Pricing program is to allow hospitals and cancer centers to reinvest their savings from these drug discounts to assure patient access to high-quality care and lifesaving cancer treatments, and to develop comprehensive services.

The new CMS rule drastically reduces Medicare Part B reimbursement rates for drug  purchases to hospitals and cancer centers participating in the 340B Drug Pricing Program. Under the new rule, CMS reimbursement for drug purchases has decreased from the prior rate of Average Sale Price (ASP) plus 6 percent, to ASP minus 22.5 percent, resulting in a cut of $1.6 billion per year to the nation’s public safety-net hospitals and cancer centers. This cut fully eliminates the benefit of the 340B drug pricing program to participating cancer centers. Despite claims by CMS and the drug industry, the new rule does not lower drug prices, save money for Medicare or for seniors, or reduce patient co-pays. In fact, the cost of lifesaving cancer drugs is predicted to increase significantly.


Read more from Dr. Willman, CEO and director of the University of New Mexico’s Comprehensive Cancer Center, in AACI’s July 2018 Commentary

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