2024 Policy Wrap-Up and ACCC 2025 Policy Priorities

In 2024, policymakers advanced several of the Association of Cancer Care Centers’ (ACCC) federal policy priorities. Many of these changes—most notably, reimbursement for patient navigation, protections for patients and providers during prior authorization processes, and reductions in out-of-pocket medication expenses for Medicare Part D beneficiaries—were implemented through federal regulatory actions.

Additionally, significant legislative proposals addressing prior authorization, Medicare physician payment, and cancer screening advanced to the final stages of the legislative process with broad bipartisan support, though they ultimately were not passed into law. ACCC hopes Congress will renew these efforts and enact these provisions in the 119th Congress.

Another key policy win was the extension of critical telehealth flexibilities into early 2025. ACCC will continue advocating for the provisions that were not enacted in 2024 during the 119th Congress.

ACCC 2025 Policy Priorities

ACCC’s policy priorities for 2025 reflect the most pressing concerns of its members. Prior authorization is now the organization’s top priority. Additional key issues include:

• Drug and medical supply shortages
• Patient navigation
• Financial toxicity
• The inflation reduction act (IRA), particularly its impact on provider reimbursement, treatment access, and affordability

In addition to these 5 core policy priorities, ACCC will continue supporting legislation to reduce Medicare physician payment cuts, extend Medicare telehealth coverage, and promote Medicare coverage for multicancer early detection (MCED) tests. ACCC will also monitor legislative, regulatory, and policy developments and respond in alignment with members’ priorities.

This article takes a deeper look at prior authorization and ongoing policy efforts to address its challenges. Future newsletters will provide further insights into other ACCC policy priorities.

Prior Authorization

Prior authorization is a utilization management tool used by many payers that requires patients or their providers to obtain preapproval for specific medications or services as a condition of coverage. While intended to ensure medical necessity, these requirements can delay treatment, lead to negative patient outcomes, and increase administrative burdens and health care costs.

In January 2024, the US Department of Health and Human Services and the Centers for Medicare & Medicaid Services published a rule on prior authorization for federally regulated plans. The rule introduces important process improvements, including:

• Required decision time frames: 72 hours for urgent requests and 7 days for nonurgent requests
• Mandatory explanations for denials
• Public reporting of key metrics

This rule applies to Medicare Advantage, Medicaid, and Children’s Health Insurance Program fee-for-service and managed care plans, as well as Affordable Care Act marketplace plans. Most provisions take effect on January 1, 2026, with reporting requirements starting in March 2026 and standardized electronic interfaces required by January 1, 2027.

While this rule represents progress, it does not apply to prior authorization for prescription drugs or many employer-sponsored health plans regulated by the US Department of Labor. ACCC will advocate for legislation to further strengthen and expand prior authorization reforms.

End-of-Year Legislative Efforts: Important Cancer-Related Proposals, Few Enacted

Several ACCC-supported legislative proposals garnered bipartisan backing, including:

• Strengthening prior authorization protections for Medicare Advantage plans
• Extending Medicare telehealth coverage beyond the COVID-19 public health emergency
• Allowing Medicare to cover MCED screening tests upon FDA approval
• Promoting breast cancer screening and pediatric cancer research

Despite strong support, most of these provisions were not enacted before Congress adjourned. However, there were 2 notable exceptions:

1. A temporary extension of Medicare telehealth flexibilities until March 31, 2025
2. Legislation to improve pediatric cancer research.

Next Steps

ACCC remains committed to advancing these policy priorities through ongoing advocacy efforts, including our upcoming annual Capitol Hill Day on March 5, 2025. The organization looks forward to collaborating with policymakers and stakeholders to promote policies that enhance access to high-quality cancer care.