Health Policy Report – February 6, 2024

Rep. Lance Gooden (R-TX) Visits Texas Oncology Mesquite

On February 1, Texas Oncology hosted Congressman Lance Gooden (R-TX) for a site visit at their Mesquite practice.  Dr. Sreeni Chittoor, joined by Drs. Naveed Cheema, Shiela Haffar, David Yin, and Zainab Ilahi as well as Practice Administrator Mary West, Practice Manager David De La Rosa, Executive Director Mary Ann Cagle, led Rep. Gooden on a tour of the practice, including the radiation vault, the infusion suite, and the pharmacy.

During the site visit, the discussion focused on the value of community cancer care, the benefits of medically integrated pharmacy services, site-of-service payment disparities, and the pressures of running an independent practice.

Congressman Lance Gooden represents the 5th congressional district in Texas, which includes parts of Dallas County, Henderson, Kaufman, Van Zandt, Wood, and Upshur counties. He serves on the House Judiciary and Armed Services Committees. The Network and Texas Oncology look forward to working with Rep. Gooden on issues impacting community oncology. 

If you are interested in hosting a site visit, please contact Lisa.Langenderfer@usoncology.com or Jasey.Cardenas@usoncology.com.

Dr. Joseph Buscema Pens Op-Ed on Need for Site Neutral Payments in Cancer Care

Dr. Joseph Buscema, gynecologic oncologist at Arizona Oncology – Tucson, recently published an op-ed in the Arizona Daily Star sharing his insight on how patients’ access to community cancer care is being threatened by site of service payment differentials that favor hospital outpatient departments (HOPDs). 

In the op-ed, Dr. Buscema highlighted how independent cancer centers provide tremendous value for patients and caregivers, offering convenient cancer care at a lower cost. “Despite these benefits, our healthcare system allows hospitals to charge and receive drastically higher payments than small, independent physician practices—for the same service,” Dr. Buscema explained. “With these dramatic differences in reimbursement, large hospitals and health systems are incentivized to buy up independent physician practices, put their name on the door, and charge higher rates for the same services.”

Dr. Buscema went on to describe how these differences in payment are driving physicians out of private practice, making it more difficult for patients to find care outside of the hospital setting. In light of these trends, Dr. Buscema expressed his support for the Medicare Patient Access to Cancer Treatment (MPACT) Act (H.R. 4473), which would ensure that the Medicare program provides equal payments for identical services provided in hospitals and community-based oncology practices. Dr. Buscema thanked Representative Debbie Lesko (AZ-08), along with Representatives Jodey Arrington (TX-19) and Michael Burgess, MD (TX-26), and urged policymakers to advance this bill quickly. 

To read the op-ed, CLICK HERE. 

To read the MPACT Act, CLICK HERE.

To contact your Member of Congress to support the MPACT Act, CLICK HERE.

The Network’s State Policy Team Advances Key Priorities

The Network’s State Policy team has begun 2024 on strong footing, advancing key legislation and meeting with policymakers from Maryland to Colorado. 

In Texas, The Network recently held an advocacy dinner to honor Representative Cody Harris (Palestine) with the Heroes Conquering Cancer Award. Representative Harris played a pivotal role in advancing and passing HB 1647, which prevents pharmacy benefit managers (PBMs) and insurers from requiring patients with chronic, complex, rare, and life-threatening conditions who are receiving care in the community setting to use PBMs’ mail-order specialty pharmacies to receive their physician administered drugs. 

The Network is replicating the success of this bill in states like Colorado, where The Network has worked closely with Rocky Mountain Cancer Care (RMCC) and Representative Iman Jodeh (Aurora) to advance legislation prohibiting white bagging. This longstanding commitment recently resulted in the introduction of HB 24-1010, which would prohibit PBMs from mandating white bagging in the physician setting. On February 2, the Colorado House Health Committee held a hearing to discuss this legislation, which featured physician and pharmacist testimony on how white bagging negatively impacts patient care. 

Meanwhile, The Network and Maryland Oncology Hematology have worked closely with Senator Clarence Lam, MD (Baltimore County), a Preventative Medicine Physician at Johns Hopkins University Hospital, and Delegate Steven Johnson, PharmD (Aberdeen) on anti-steering legislation. The Maryland Senate has introduced SB 526, which would prevent steering of specialty medications that are dispensed or administered in the physician office setting – including white bagging of infused or injected drugs, as well as mail order steering of oral medications. The bill is expected to receive a hearing in the Maryland Senate Finance Committee on February 14. 

In New Mexico, The Network and Nexus Health hosted an advocacy dinner that brought together key members of the New Mexico House and Human Services Committee and Senate Health and Public Affairs Committee. During the discussion, Nexus Health tackled crucial topics including reforms in prior authorization, oversight and transparency in PBMs and the challenges posed by anti-competitive pressures from hospitals that disrupt timely access to care.

Finally, in Indiana, The Network and Northwest Cancer Centers attended the American Cancer Society (ACS) Cancer Action Network (CAN) Action Day in Indianapolis to advocate in support of SB 273, which would expand coverage of biomarker testing. The Network met with Senator Dernulc (Dyer), Senator Vinzant’s (Hobart) staff, and other legislative staff across the Northwest Indiana region to discuss community oncology priorities. 

The Network looks forward to continuing to work alongside practices throughout 2024 to champion policies that bring community cancer care closer to patients.

To read HB 1647 in Texas, CLICK HERE.

To read more about The Network’s advocacy dinner in Texas, CLICK HERE.

To read HB 24-1010 in Colorado, CLICK HERE.

To read SB 526 in Maryland, CLICK HERE.

To read more about The Network’s advocacy dinner in New Mexico, CLICK HERE.

To read SB 273 in Indiana, CLICK HERE.  

New Study Reveals Substantial Drug Markups Among 340B-Eligible Hospitals

A new study published in the New England Journal of Medicine reveals that hospitals participating in the 340B Drug Pricing Program significantly marked up the cost of outpatient infusion drugs for privately insured patients when compared to other hospitals. Further, these hospitals’ markups were over six times higher than in independent practices, while non-340B eligible hospitals’ markups were over four times higher than those seen in independent practices. 

Similarly, the 340B hospitals held on to more profit, retaining 64.3% of insurer expenditures compared with 44.8% among non-eligible hospitals and just 19.1% at independent physician practices.

Researchers at the University of California, Berkeley, who authored the study, say the findings show the 340B program is not working as intended. The study comes as Senator Bill Cassidy (R-LA), ranking Republican on the Senate Committee on Health, Education, Labor and Pensions (HELP), is undertaking a major investigation into how 340B-covered entities derive revenue through the program. This month, Senator Cassidy asked the two largest contract pharmacies, CVS Health and Walgreens, participating in the 340B Drug Pricing Program to provide information on how they generate revenue and how that money is being utilized. 

To read more, CLICK HERE.

To read Sen. Cassidy’s letter to CVS Health, CLICK HERE, and the letter to Walgreens, CLICK HERE.

Senators Request Update on FTC’s PBM Investigation

On January 22, a bipartisan group of 14 senators wrote a letter to the Federal Trade Commission (FTC) requesting an update on their investigation into the practices of pharmacy benefit managers (PBMs). The investigation, which began in June 2022, has not had any public updates or status reports.

In their letter, the senators highlighted the need to examine these practices, which many say will drive up drug prices, limit patient access, and reduce the viability of independent pharmacies. “Recent consolidations between PBMs, insurance providers, and other healthcare entities have resulted in vertical integration whereby a small number of companies now manage the vast majority of prescription drug benefits.”

The letter was signed by Senators Charles Grassley (R-IA), Maria Cantwell (D-WA), James Lankford (R-OK), Peter Welch (D-VT), Susan Collins (R-ME), Cindy Hyde-Smith (R-MS), Christopher Coons (D-DE), Tommy Tuberville (R-AL), Jerry Moran (R-KS), Jon Tester (D-MT), Shelley Capito (R-WV), Thom Tillis (R-NC), Mazie Hirono (D-HI), and Marsha Blackburn (R-TN).

To read the senators’ letter to the FTC, CLICK HERE.

Senate Finance Committee Unveils Draft Legislation to Curb Drug Shortages

Senate Finance Committee Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) recently announced their commitment to working on bipartisan healthcare legislation to prevent and alleviate generic drug shortages.

Specifically, the senators published a white paper outlining policy options to address shortages through modifications to the Medicare and Medicaid programs. These include Medicare Part A and B payment reforms to stabilize the supply of generic sterile injectable medicines, new incentives for stakeholders to engage in shortage prevention and mitigation activities, reforms or pilot programs in Medicare Part D to encourage pharmacies to purchase generic medicines from manufacturers, and potential reforms to the Medicaid Drug Rebate Program targeting generic medicines in shortage.

“It is unacceptable that cancer patients and people suffering from chronic conditions in Oregon and across America are struggling to get lower cost, generic medication they need,” Wyden said. “Addressing the generic drug shortage crisis in Oregon and across America is urgent business, and Ranking Member Crapo and I are firmly committed to using the power of Medicaid and Medicare to do just that.”

To read the Senate Finance Committee’s statement, CLICK HERE.

To read the white paper, CLICK HERE.

CMS Releases RFI on Medicare Advantage

On January 25, the Department of Health of Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) intended to help the federal government increase transparency of Medicare Advantage (MA) plans and improve CMS’ data capabilities to perform oversight over this rapidly growing program.

Specifically, CMS is seeking data-related input from the public related to all aspects of the MA program including access to care, prior authorization, provider directories, and networks; supplemental benefits; marketing; care quality and outcomes; value-based care arrangements and equity; and healthy competition in the market, including the effects of vertical integration and how that affects payment. With the 120-day public comment period now open, comments may be submitted by May 29, 2024.

The new RFI is the latest effort by CMS to update its data collection and reporting efforts to increase transparency and accountability over the Medicare Advantage program, which has grown to over 50% of Medicare enrollment, and for which the federal government is expected to pay MA health insurance companies more than $7 trillion over the next decade. During the Biden-Harris Administration, CMS began collecting supplemental benefit reporting categories and detailed Medical Loss Ratios (MLR) data; voluntary race and ethnicity data on MA and Part D enrollment forms; and, has encouraged more complete and accurate reporting of encounter data by MA organizations.

To read the CMS press release about the RFI, CLICK HERE.

To read the text of the RFI, CLICK HERE.