November 22: Breaking News: Medicare Part B Experiment Dead

The Community Oncology Alliance (COA) believes that, for all intents and purposes, the Medicare Part B experiment (demo) on cancer care is dead.

Late last week, top Democrats, including incoming Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi, requested that the Obama administration not release the final rule implementing this perverse experiment on seniors’ cancer care via drug reimbursement cuts.

Combined with the fact that Friday was the last day the rule could have been released and implemented under the Obama administration – there is a 60-day hold period from the date a rule is released to when it can be put into effect – COA is extremely optimistic that the Medicare Part B experiment on cancer care is dead.

There is a small chance the Part B experiment could still be released, but that is why COA is taking nothing to chance and spent last week in DC talking to members and staff about using the Congressional Review Act to stop the rule, if released. This, plus other extensive preparations we have made, means we are ready to act quickly and decisively if it is revived.

This Thanksgiving holiday COA is thankful for your ongoing support and the team effort put in by the entire cancer care community to stop this misguided experiment!

Fundamental to the success was intense advocacy by COA, our members, patients, and many others on Capitol Hill and in communities across the country. This work generated an enormous amount of news media coverage, OpEds, and social media activity during this fight. COA alone delivered over 70,000 calls, emails, and letters to Congress opposing the Part B experiment.

Talk is cheap. This is something that we see all too often in DC. But the cancer community backed this fight with real action. It is clear that the pressure we put on Congress played a big part in driving the delay and ultimately death of the Part B experiment.

Going into winter, COA moves on to the next set of issues, including ending the sequester cut applied to Part B drugs and the ongoing challenge to high quality patient care that practices face from pharmacy benefits managers (PBMs).

COA has always believed that CMS should not be applying the sequester cut to Part B drugs in keeping with the same reason why the Part B experiment was simply not legal: the reimbursement rate of ASP + 6% is defined and locked in law (by the Medicare Modernization Act of 2003). CMS cannot unilaterally overturn statute established by Congress. We are preparing our case and have had several meetings on the Hill about this. It will be an uphill battle, but with the new (incoming) administration and backing of a Republican Congress there is an opening on this issue.

On the PBM front, we are going to aggressively take on DIR fees, self-steerage to PBM-affiliated mail order and specialty pharmacies, and restrictive formularies hurting patients’ access to drugs. Stay tuned for a lot more on these issues in the coming months, including a soon-to-be-released white paper.

The fight goes on for cancer patients and their access to the highest quality, affordable care close to home!

On behalf of everyone at COA, Happy Thanksgiving to you and your family.