FOR INFORMATION CONTACT:
Lori Gardner, Senior Director
Communications & Marketing
301.984.9496 ext. 226
For Immediate Release: September 20, 2005
Changes in Medicare Payments and Coverage Policies Could Irrevocably Alter Patient Access to Innovative Cancer Therapies
Association of Community Cancer Centers (ACCC) Examines Potential Outcomes of 2005 Reimbursement Rates at its 21st Oncology Economics Conference
ROCKVILLE, Md.—Several changes to reimbursement methodologies effective January 1, 2005, as well as a pending national coverage determination review by the Centers for Medicare and Medicaid Services (CMS) of off-label use of four drugs, are raising serious concerns among ACCC member physician office practices and hospital outpatient cancer programs.
The 2005 Proposed Physician Fee Schedule rule includes average sales price (ASP) data for 32 drugs. Although final rates will be established based on more current pricing data submitted by manufacturers, these early estimates provide an indication of the likely reductions that providers should expect in drug reimbursement rates.
"To the extent that final ASP rates approximate those published in the Proposed Rule, some oncology practices may be unable to continue offering the full range of cancer care services. The anticipated reduction in total revenue is bad news for some physician practices, and potentially disastrous for others," stated Deborah Walter, senior director, Policy and Governmental Affairs, and a presenter at the upcoming ACCC Oncology Economics Conference in Salt Lake City, Utah.
"It is troubling that in some markets, patient access to needed therapies could be dictated by physicians’ purchasing power—based on market share and volume," she noted.
ACCC is also concerned about how treatment and patient care could be affected by CMS' decision to modify its national coverage determination review to include consideration of off-label uses of four innovative oncology drugs used to fight colorectal cancer and non-Hodgkins lymphoma, including oxaliplatin (Eloxatin®), irinotecan (Camptostar®), bevacizumab (Avastin®), and cetuximab (Erbitux®), that are not listed as indicated in one or more of the major drug compendia. Historically, coverage decisions on off-label uses are made at the local level not the national level, which allows for more flexibility in developing coverage policy and faster recognition of innovative uses of new therapies than would be possible with a nationwide decision.
According to Deborah Walter, “it is increasingly apparent that CMS may be improperly considering cost, rather than medical criteria, in deciding whether to cover the off-label uses of cancer drugs. Such coverage restrictions could undermine any gains that have been made in improving access to medicines prescribed by physicians for off-label uses," she added. A panel of speakers, including Deborah Walter, will examine the potential impact of changes that may impact physician's ability to provide cancer care as well as update conference attendees about recent ACCC efforts to protect access to quality care.
For details on these sessions and other conference offerings, as well as registration, visit ACCC's web site at www.accc-cancer.org/meetings or call 301.984.9496, ext. 213 or 215. Reporters may register for complimentary conference media passes either on site or by calling 301.984.9496, ext. 208.