Dr. Bailes Testifies at Congressional Hearing

In a hearing convened by House Ways and Means Subcommittee on Health chairwoman Nancy Johnson (R-CT), Congress sought input on the effects of the new average sales price (ASP) payment system for cancer drug reimbursement on the delivery and access of cancer care. American Society of Clinical Oncology (ASCO) interim executive vice president and chief executive officer, Joseph S. Bailes, MD, testified at the hearing.

Representatives from Medicare, other federal government bodies, and provider and patient groups also testified. Dr. Bailes stated that ASCO will continue working in a collaborative manner with those in the cancer care community and on Capitol Hill who support long-term, sustainable change to the Medicare system that will ultimately improve the quality of cancer care for Medicare patients.

Reimbursement Unbalanced

At the hearing, Dr. Bailes noted that the Medicare reimbursement statute is unbalanced, since it allows the Centers for Medicare & Medicaid Services (CMS) to lower the ASP payment rate when it exceeds the widely available market price, but does not permit raising the ASP payment rate when it is less than the price most oncology practices are paying.

To avoid potential access problems for cancer patients, Dr. Bailes reiterated ASCO's support for H.R. 5179. This bill, introduced by Rep. Ralph Hall (R-TX), would create a floor for Medicare payments and would exclude from the ASP calculation the prompt-pay discounts to wholesalers and distributors.

Dr. Bailes testified that current Medicare payments do not adequately cover the cost of providing the complex array of services required for comprehensive cancer care. According to Dr. Bailes, further legislative changes are needed to provide these critical patient services.

Dr. Bailes reiterated ASCO's support for legislation that provides appropriate reimbursement for development of a comprehensive cancer care plan.

Calculating Expenses

He also stated that CMS must revise its methodology used in calculating the practice expenses associated with particular services because it does not adequately capture the time and expertise needed for certain aspects of cancer care.

Dr. Bailes explained to the Subcommittee that the CMS oncology demonstration projects of 2005 and 2006 allowed voluntary billable resources that enabled oncology practices to continue to provide high-quality cancer care to their patients.

Extend the Demonstration Project

Thus, Dr. Bailes urged the subcommittee to support a multiyear extension of the CMS demonstration project, to allow for collection of enough data to support well-informed quality enhancement initiatives.

Finally, Dr. Bailes noted that the 20% coinsurance payment for chemotherapy for Medicare patients enrolled in Part B is an untenable financial weight on many patients and is also a contributing factor to the "bad debt" burden of oncology practices. He recommended that Congress reduce or eliminate the coinsurance payment for Part B drugs.