Health Policy Reports

Biweekly newsletter of stories impacting community cancer care.
January 23, 2024

Health Policy Report – January 23, 2024

The Network Meets with Congressional Staff on MID Home Delivery

On Wednesday, January 17, Dr. Debra Patt and Dr. Gury Doshi of Texas Oncology along with The US Oncology Network Federal Government Relations team met with staff of Rep. Lizzie Fletcher (D-TX) and Rep. Colin Allred’s (D-TX) office to discuss the importance of patients receiving their medications through Medically Integrated Dispensing. Rep. Fletcher is a member of the House Committee on Energy & Commerce and serves in the Houston area, while Rep. Allred is a member of the House Foreign Affairs committee serving the Dallas area.

As part of The Network’s efforts to find a solution to The Centers for Medicare and Medicaid Services (CMS) May 2023 FAQ on MID Home delivery, we have continued to meet with key Congressional members to raise awareness of this issue that has impacted patients.

During the meetings, Dr. Debra Patt spoke directly about the direct impact to patients at Texas Oncology and how the FAQ has caused delays in filling prescriptions and how it is important for physicians to monitor patient vital levels and adjust dosages throughout the treatment process.

Dr. Doshi spoke about the importance of the MID platform while sharing data from the ASCO Quality Care Symposium abstract that identified over 900 patients at Texas Oncology with Medicare Part D who would no longer be able to utilize their physician’s pharmacy for home delivery of their specialty medications as a result of the CMS FAQ.

The discussions also focused on The Senior’s Access to Critical Medications Act of 2023 (H.R. 5526) introduced by Rep. Diana Harshbarger (R-TN) and Rep. Debbie Wasserman Schultz (D-FL), which would amend the Social Security Act to allow physicians to mail or allow a family member or caretaker to pick up medications on behalf of a patient.

The Network looks to continue advocating on this important issue and will continue its outreach to Congress advocating for a solution to the CMS FAQ home delivery issue. 

To read more about The Senior’s Access to Critical Medications Act (H.R. 5526), CLICK HERE.

To take action and ask your Member of Congress to restore patient access to home delivery of oral oncolytics, CLICK HERE.

The Network’s State Government Relations Team Testifies on White Bagging at Oregon Capitol

On Friday, January 12, Dr. Ian Schnadig from Compass Oncology and Ryan Solt from the US Oncology Network’s State Government Relations and Public Policy team had the opportunity to present to the members of the Oregon House Committee on Behavioral Health and Health Care. The focus of their presentation was the concerns community oncology practices have regarding white bagging mandates. Dr. Schnadig began by providing the committee with insights into how care is currently delivered in the community setting and how introducing the practice of white bagging could significantly impact patient care. 

Their goal was to emphasize the adverse effects of white bagging on patient care and cancer treatment, which include:

  • Delay in care
  • Creating drug waste
  • Increasing patient costs
  • Threats to drug supply chain integrity
  • Threats to practice viability

The US Oncology Network zgovernment relations team, in collaboration with Compass Oncology and Willamette Valley Cancer Institute, is actively working on a bill to prohibit PBMs and payers from mandating white bagging during the 2024 legislative session. 

To watch the hearing, CLICK HERE.

Congress Passes Short-Term Continuing Resolution (CR) Ahead of Jan. 19 Funding Deadline

Congress has passed another short-term continuing resolution that would keep the government funded through March, avoiding a potential shutdown that would have otherwise taken place on January 20. The new stopgap measure will preserve the two-step schedule of the previous CR, with some agencies, including the Food and Drug Administration (FDA), set to run out of funding on March 1, while the rest, including the Department of Health & Human Services (HHS), being funded through March 8. Unfortunately, the stopgap bill did not include any new healthcare policies, such as an increase in the Medicare Physician Fee Schedule.

With more time for Congress to make a deal or move to another round of negotiations, lawmakers will be jockeying for a physician payment fix, PBM reform, price transparency, and site neutral payment for drug administration, a policy included in the Lower Costs, More Transparency Act (HR 5378).

While the House passed the Lower Costs, More Transparency Actlate last year, the Senate Finance Committee has not formally considered the site neutral policy included in the bill, leaving the provision with no certain path forward. “We’re in active negotiation, there’s a lot of momentum, we’re going to keep working it,” House Energy and Commerce Chair Cathy McMorris Rodgers (R-WA) stated when asked about the policy’s chances in the Senate. 

While the bill only extended healthcare-related measures that were included in the previous funding bill, Congress must continue negotiations to include a Medicare physician payment fix through the Preserving Seniors’ Access to Physicians Act of 2023 (H.R. 6683), which was left unaddressed and open for consideration until the March deadlines.

To read more, CLICK HERE.

To reach out to your Member of Congress to support Physician Payment, CLICK HERE.

To read the Lower Costs, More Transparency Act (HR 5378), CLICK HERE.

To read The Preserving Seniors’ Access to Physicians Act of 2023 (H.R. 6683), CLICK HERE.

Biden Administration Drops Copay Accumulator Appeal

On Tuesday, January 16, the Biden administration moved to drop its appeal of a recent court ruling striking down a 2021 rule from the Department of Health and Human Services (HHS) that allowed insurers not to count coupons from drugmakers towards patients’ maximum deductibles and out-of-pocket costs. 

The administration’s decision comes after bipartisan pressure from Congress who sent a letter signed by 48 members and criticisms from patient groups that argue an appeal would make it more difficult for patients to afford care. Now that the government has dropped its appeal, insurance companies and pharmacy benefit managers (PBMs) must follow a 2020 rule that allows copay assistance to count towards deductibles. 

“We are pleased that the government has withdrawn its appeal of our court victory for patients who struggle to afford their prescription drugs and rely on copay assistance,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, a plaintiff in last year’s lawsuit along with the Diabetes Leadership Council and the Diabetes Patient Advocacy Coalition.

To read more, CLICK HERE.

To read the Congressional letter to HHS, CLICK HERE.

To read a press release from the HIV+Hepatitis Policy Institute, CLICK HERE.

CMS Finalizes Prior Authorization Rule

On Wednesday, January 17, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that establishes an electronic prior authorization system, establishes a timeline for prior authorization decision making, and requires payers to set up an interface to share clinical and claims data as patients change plans. 

Specifically, the rule requires Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, and CHIP managed care entities to send prior authorization decisions within 72 hours for expedited requests and 7 calendar days for standard requests.

For providers, the final rule encourages the adoption of electronic prior authorization processes by adding a new measure for Merit-based Incentive Payment System (MIPS) eligible clinicians under the Promoting Interoperability performance category of MIPS.

The Department of Health and Human Services (HHS) anticipates that the changes will result in approximately $15 billion in savings over 10 years. “Increasing efficiency and enabling health care data to flow freely and securely between patients, providers and payers and streamlining prior authorization processes supports better health outcomes and a better health care experience for all,” said CMS Administrator Chiquita Brooks-LaSure.

Several physician groups praised the final rule. “Today’s final rule requires impacted plans to support an electronic prior authorization process that is embedded within physicians’ electronic health records, bringing much-needed automation and efficiency to the current time-consuming, manual workflow,” American Medical Association (AMA) president Jesse Ehrenfeld, MD, MPH, noted in a statement.

Some groups, however, expressed concern that the new requirements will place undue strain on physicians. “However, the ACR is concerned with the inclusion of e-prior authorization measures for merit-based incentive payment system (MIPS)-eligible providers under the performance improvement (PI) category as it will create additional burden for physicians,” the American College of Rheumatology (ACR) wrote in a statement.

To read the rule, CLICK HERE.

To read a fact sheet about the rule, CLICK HERE.  

To read more, CLICK HERE.

To read the AMA’s statement, CLICK HERE.

To read the ACR’s statement, CLICK HERE.

MedPAC Recommends Pay Increase for Doctors

On Friday, January 12, the Medicare Payment Advisory Commission (MedPAC) recommended a 1.3% increase to the Medicare Physician Fee Schedule (MPFS) in 2025—or about half the rate of inflation experts project for medical practice costs.

Last year MedPAC also recommended increasing physician payments along with the rise of inflation, but instead, the Centers for Medicare & Medicaid Services (CMS) finalized a 3.37% cut to the MPFS for 2024, which went into effect on January 1. Physician groups, led by the American Medical Association, have long called on Congress to adopt reforms to stabilize the Medicare payment system and ensure practices are able to keep their doors open and continue serving seniors. While Congress failed to act to avert the latest cuts before they went into effect, lawmakers are championing several bills to address the problem.

One bill, the Strengthening Medicare for Patients and Providers Act (H.R. 2474) is intended to link annual MPFS updates to the Medicare Economic Index, which is tied to inflation. In December, Rep. Greg Murphy, MD (R-N.C.), co-chair of the House GOP Doctors Caucus, introduced the Preserving Seniors’ Access to Physicians Act (H.R. 6683), which would completely reverse the 3.37% cuts for 2024.

In addition to the MPFS recommendation, MedPAC put its weight behind several other payment increases including a 1.5% payment increase to hospitals for inpatient and outpatient services and additional payments for physicians who serve low-income Medicare patients next year.

To read more about this issue, CLICK HERE.

To read the AMA’s statement on MedPAC’s recommendation, CLICK HERE.

To reach out to your Member of Congress to support Physician Payment, CLICK HERE.

To read more about the Strengthening Medicare for Patients and Providers Act (H.R. 2474), CLICK HERE.

To read more about the Preserving Seniors’ Access to Physicians Act (H.R. 6683), CLICK HERE.

HHS Names First-Ever Chief Competition Officer

On Thursday, January 4, the Department of Health and Human Services (HHS) Secretary Xavier Becerra appointed Stacy Sanders as Chief Competition Officer. This newly established role is a pivotal component of the Biden administration’s strategy to boost competition and lower healthcare and prescription drug costs.

Sanders is tasked with coordinating, identifying, and elevating opportunities to bolster competition in health care markets, including spearheading conversations with key entities such as the Federal Trade Commission (FTC) and Department of Justice (DOJ). While the FTC and DOJ have historically led antitrust enforcement, HHS and CMS have a great deal of power over health care payment and policies that can incentivize or disincentivize health care businesses to engage in anticompetitive behavior.

“We know that increased competition in the marketplace is a good deal for the American people,” Sanders said in a press release. “I look forward to supporting the Biden-Harris Administration’s efforts to increase competition in health care and lower costs, helping build on steps the Administration has already taken as well as identify opportunities to further spur innovation.”

To read the announcement, CLICK HERE.