Congressman Michael C. Burgess, M.D. (R-TX), U.S. Congressman Pete Sessions (R-TX), Congressman Gene Green (D-TX), Congresswoman Allyson Schwartz (D-PA), Congressman Ed Whitfield (R-KY) and Congressman Ron Kind (D-WI), led a bipartisan group of more than 100 of their House colleagues in sending a letter to the Centers for Medicare and Medicaid Services (CMS) asking for information regarding its implementation of the two percent sequester cut to Medicare payments to providers. The lawmakers expressed particular concern for its impact on Medicare Part B drugs -- specifically chemotherapy and other specialty infusible drugs.
The letter urged CMS to clarify to Congress both its statutory authority to reduce Medicare Part B drug reimbursement and its understanding of Office of Management and Budget (OMB) guidance directing federal agencies to use any available flexibility when implementing the sequestration spending cuts to reduce operational risks and minimize its impact on the American people. Moreover, the bipartisan letter challenged CMS to use what flexibility it has available to direct the cuts away from patients.
The pricing for cancer drugs covered under Medicare Part B is a formula -- Average Sales Price (ASP) plus six percent -- intended to reimburse cancer clinics and other providers for their drug acquisition costs at average market rates. This reimbursement formula is comprised of both the fixed cost of the drug -- ASP -- and an additional physician services payment -- six percent -- that covers costs for inventory, facilities, storage, handling and waste disposal associated with these drugs.
"The Centers for Medicare and Medicaid Services need to explain the legal authority it used in applying sequestration to Medicare Part B drug reimbursement particularly in the oncology space since the Medicare Modernization Act of 2003 determines that reimbursement in statute," said Burgess. "I am concerned as to why CMS has decided to apply sequestration to the entire reimbursement amount and not just to the physicians services, and if they had to apply the cut at all in this space. I am glad that in an overwhelming bipartisan fashion we are questioning a seemingly basic misunderstanding of math and why CMS did not take the impact to patients and health care providers into account in exercising available flexibility. These concerns need to be addressed by CMS as soon as possible."
"Since sequestration cuts took effect, news reports of cancer clinics turning away thousands of Medicare patients have circulated across our nation," said Sessions. "As a Member of Congress, I believe it is my responsibility to seek answers from agencies and departments here in Washington that make decisions and take actions that could impact my constituents. I remain committed to ensuring that North Texans -- and all Americans -- have access to their health care professionals and the treatments they need."
"It's critical that access to quality care is not diminished because of sequestration," said Green. "This letter is important so patients, providers, and Congress can get clarity on how CMS plans to move forward. I am concerned that if sequestration cuts are applied to the entire drug payment, many beneficiaries will lose access to their current providers. I am pleased to be joined by such a large bipartisan coalition raising questions about these cuts and I look forward to working with my colleagues and CMS to mitigate the effects of the cuts on beneficiaries and providers."
"Implementing mandatory cuts to Medicare funding in this way will have a devastating effect on millions of cancer patients across America," said Schwartz. "We must do everything in our power to ensure that cancer patients in Pennsylvania and nationwide continue to have access to the quality, affordable treatment they need in their own community."
"While there is certainly a need to curtail excessive government spending, we should not be disproportionally targeting those battling cancer," said Whitfield. "The Centers for Medicare and Medicaid Services need to use any flexibility available when applying sequestration to Part B drugs such as those used to treat cancer patients."
"We're calling on CMS to do whatever they can to ease the burden of the sequester on people bravely fighting cancer," said Kind. "We need to take action now, before more patients lose access to life-saving cancer drugs."