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Lori Gardner, Senior Director
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For Immediate Release: November 6, 2007
Association of Community Cancer Centers Responds to CMS's 2008 Hospital Outpatient Prospective Payment System Rule
ACCC fears drop in drug reimbursement may lead to patient access issues
ROCKVILLE, Md.—On Nov. 1, 2007, the Centers for Medicare & Medicaid Services (CMS) released its final 2008 Hospital Outpatient Prospective Payment System (HOPPS) Rule. Included in the rule is a decrease in drug reimbursement from Average Sales Price (ASP) +6 percent to ASP+5 percent, with an eventual decrease to ASP+3 percent for 2009.
ACCC does not believe that these levels provide adequate reimbursement for many common anti-cancer and cancer-related therapies. "The costs associated with delivering these drugs in hospital outpatient departments do not even come close to the reimbursement," said Richard B. Reiling, MD, FACS, ACCC President.
ACCC is concerned that the pharmacy overhead costs associated with delivering many of these treatments are not being factored into the costs of the drugs, which is why many hospitals may be losing money on certain treatments. ACCC proposed a plan to CMS to reimburse for these overhead charges; however, CMS did not include the plan in the final rule.
“Pharmacy overhead costs can be significant, especially in the outpatient department, and we fear that a continued refusal to account for these costs on the part of CMS may lead to an issue of patient access down the road,” said Matthew Farber, MA, Manager of Economics and Public Policy at ACCC.
ACCC is beginning to notice a trend of private payers moving to reimburse drugs on the ASP system as well, away from the Average Wholesale Price (AWP) system they currently use. This shift, along with the continuing decrease in reimbursement from CMS, may lead to serious deficiencies in patient access.
"More patients are being sent and treated in outpatient facilities as the reimbursement in the physicians' offices is also slashed," said Dr. Reiling. "At some point it will occur that no one can afford to provide chemotherapeutic services; we are not far from that threshold now."
ACCC will continue to work with CMS on the issues of proper reimbursement for drugs and pharmacy costs in hopes of ensuring patient access to critical therapies in the future.