#AMCCBS: Advocating on Capitol Hill

As part of the 51st Annual Meeting & Cancer Center Business Summit (#AMCCBS), the Association of Cancer Care Centers (ACCC) welcomed its members to the nation's capital for Hill Day. This longstanding tradition is a unique opportunity for ACCC members to meet with members of Congress and their staff to inform them of priority issues affecting access to and delivery of quality cancer care. Open to providers and administrators at health care institutions, ACCC Capitol Hill Day allows members to advocate for legislative and policy changes to support their cancer care community and the patients they serve.

ACCC member Sucharu (Chris) Prakash, MD of Texas Oncology spoke to the value of advocating for key issues in person. “These members of Congress and their staff really listen,” he said. “They value our opinion as providers, they want to know what issues we face in our day to day practice, and they make an effort to enact changes.”

In 2025, ACCC is concentrating its advocacy efforts on 5 issues that were identified by its membership as integral to cancer care providers and the patients they serve: prior authorization, oncology drug and medical supply shortages, patient navigation, financial toxicity, and the Inflation Reduction Act.

Sucharu (Chris) Prakash, MD; Cassandra Marakov; and Patricia Serna, MHS, PA-C, CGRA.

Prior Authorization

Prior Authorization (PA) is a utilization management mechanism used by many payers that generally requires patients or providers to secure preapproval as a condition of coverage. While intended to ensure that only medically appropriate and necessary services are provided, PA often poses administrative burdens on physicians and leads to delays in care that end up harming patients. In a 2023 survey from the American Medical Association (AMA), physicians reported that PA always (14%), often (41%), or sometimes (39%) results in delays in treatment. The same survey found that physicians and their staff spend an average of 12 hours per week completing 43 PAs, and over 25% of those PAs were denied. 

“The emotional and psychological toll of those stop gaps in treatment is significant,” stated Nikki Hamming RN, MSN, from Corewell Health. “Waiting for administrative work is detrimental to patient outcomes, and we’re seeing it at all levels.” 

In light of these concerns for patient outcomes and treatment delays, PA requirements are top of mind for cancer care providers. ACCC encourages Congress to reintroduce and enact the Seniors’ Timely Access to Care Act, which will address certain PA challenges, and to support the retainment of the Department of Health and Human Services (HHS) regulation issued in January 2024. This regulation requires certain plans to send PA decisions within a specified timeframe, to provide a reason for denials, and to publicly report certain metrics. 

Rachel Radwan; Nikki Hamming RN, MSN; Kenneth Endo; Representative Hillary Scholten (D-MI); Barbara Schmidtman, PhD; Erin Barrus, MS; and Lawrence Wagman, MD.

Oncology Drug and Medical Supply Shortages

While the shortage of platinum-based therapies that occurred in 2023 has improved, shortages of essential cancer medicines continue to be an issue. According to a 2024 National Comprehensive Cancer Network (NCCN) survey, 89% of centers reported shortages of anticancer agents and supportive care medications, and most were experiencing more than 1 shortage at the time. A significant proportion of respondents also reported that shortages impeded clinical trials and led to treatment delays. 

In a meeting with Representative Hillary Scholten (D-MI), Barbara Schmidtman, PhD, from Corewell Health discussed how the shortage of platinum-based therapies forced many cancer centers to ration their limited supply and only administer it to those patients receiving life-saving treatment, rather than life-sustaining. “It’s devastating to tell a patient who has 6 months to live that they can’t receive the drug that they need,” emphasized Dr. Schmidtman. “It’s impossible to quantify what that extra 6 months of life will mean to that patient, and we never want to take that choice away from them.”

In response to this ongoing challenge, ACCC asks that Congress use ACCC and its membership as a resource and partner as it evaluates and prioritizes federal legislative efforts to avoid, mitigate, and solve oncology drug and medical supply shortages, in addition to identifying, evaluating, and proposing short-term policies to address future shortages when they occur. ACCC members also recognize that long-term, systemwide solutions are needed to avert future shortages, and are committed to working with Congress, policymakers, and partners in the public and private sector to help devise and implement lasting solutions.

Patient Navigation

Receiving a cancer diagnosis means not only coping with the disease, but navigating its psychosocial and financial consequences. The involvement of a multidisciplinary cancer care team is therefore pivotal to aiding patients in this endeavor, with patient navigators playing a key role. Historically, patient navigators’ services were either not reimbursed or reimbursed at low levels, causing many cancer programs to rely on charitable funding to keep these supportive services afloat.

On January 1, 2024, new Healthcare Common Procedure Coding System codes went into effect—Principal Illness Navigation and Peer Support Services, assessments relating to Social Determinants of Health, and the provision of Community Health Integration Services—allowing Medicare to reimburse for certain patient navigation services. The implementation of these codes has been crucial in expanding access to these important services, and ACCC applauds policymakers for moving this issue forward.

“Patient navigators are the oil that keep the wheels moving from screening and diagnostics all the way through treatment and survivorship,” explained Lawrence Wagman, MD, from City of Hope. “Their role in cancer care is absolutely vital, and the new reimbursement model reflects that.” 

In addition, the American Medical Association issued updated guidance on the appropriate use of Current Procedural Terminology codes at the end of 2023, which enabled providers to bill and receive reimbursement for patient navigation services from many payers. ACCC asks members of Congress to continue their ongoing dialogue with ACCC members and other stakeholders as the patient navigation reimbursement codes continue to be implemented, and extends its appreciation for the ongoing partnership with policymakers that led to this step forward.

Anna Buehl, MBA, MSN, RN, NE-BC; Laura D'Onofrio; Emily Wire; Wendi Waugh, BS, RT(R)(T), CMD, ODS, FACCC; Jenny Scott; and Sarah Hudson-DiSalle, PharmD, RPh, FACCC.

Financial Toxicity

Many patients with cancer and survivors face out-of-pocket costs during diagnosis and treatment and struggle with medical debt long after treatment concludes. This financial toxicity can extend to patients’ families and caregivers as well, and tends to coincide with lower quality of life, more symptoms, and more pain. In a meeting with ACCC members, Representative Dwight Evans (D-PA) commented on the importance of using the term financial toxicity in conversations with members of Congress to accurately depict the level of economic distress patients with cancer experience as a result of treatment costs.

In response, members of Congress and policymakers at the federal and state levels are seeking to reduce the burden of out-of-pocket costs through enacted or proposed reforms that include changes to Medicare, Medicaid, and private-payer coverage. One example is the recent change to the Medicare Part D prescription drug program, which capped out-of-pocket expenses for covered medicines at $2000 per year. ACCC encourages Congress to continue to consider legislation to help alleviate financial toxicity for patients with cancer.

Inflation Reduction Act

The Inflation Reduction Act of 2022 (IRA) contains several provisions aimed at reducing prescription drug prices and costs for patients and seeks to lower prescription drug spending under the federal Medicare program. Several of these provisions have and will likely continue to provide significant savings for Medicare beneficiaries. It is therefore important that policymakers implementing the IRA continue to consider the role innovative therapies play in lengthening and saving patients’ lives. 

ACCC asks that Congress enact the Protecting Patient Access to Cancer and Complex Therapies Act, which seeks to mitigate the impact of any reduced Medicare reimbursement under Medicare Part B for providers and health care practices. This bill would help ensure that multidisciplinary care teams can continue to administer therapies covered by Medicare Part B and provide patients with the highest level of care. 

“The highlight of Hill Day is representing the patients we see every day,” said Patricia Serna, MHS, PA-C, CGRA of Texas Oncology. “If we can improve patients’ outcomes, quality of life, and access to care by advocating, then we’ve done our job.”

Stay tuned for more coverage of the ACCC 51st AMCCBS on the ACCCBuzz Blog and follow @ACCCBuzz on X for real-time updates.