Health Policy Report – June 25, 2024

Texas Oncology Hosts Congressman Nathaniel Moran (TX-01)

On Monday, June 17, Texas Oncology – Tyler hosted Congressman Nathaniel Moran (TX-01) for a tour of their Northeast Texas Cancer & Research Institute in Tyler, Texas. In attendance were Dr. Mark Saunders, Dr. Thomas Gregory, Dr. Donald Richards, Dr. Jordan Toulouse Buess, Doug Barnard, Neal Dave, PharmD, and Travis Walters.

Notably, Texas Oncology Tyler leads the state in offering the most clinical trials, providing cutting-edge treatment options to patients. Congressman Moran recognized the center’s dedication to advancing cancer care and the importance of local support and innovation in improving patient outcomes.

Congressman Moran is a freshman member of Congress who sits on House Foreign Affairs, House Education and the Workforce, and House Judiciary Committees. The US Oncology Network looks forward to working with him on these important issues facing community oncology.  If your practice is interested in hosting a site visit, please reach out to Lisa.Langenderfer@usoncology.com or Jasey.Cardenas@usoncology.com.  

Avalere Publishes Study on Payer White Bagging Requirements
Avalere, in partnership with the National Infusion Center Association (NICA), Infusion Providers Alliance (IPA), and The US Oncology Network published a study entitled, “Payer White-Bagging Requirements: Considerations for Access to Infusion Care.” The study seeks to understand the financial impact of specialty pharmacy acquisition models, including the estimates of the financial effects of white bagging as a growing model for the acquisition and delivery of provider-administered drugs and costs experienced by infusion practices, payers, and patients.

The study’s findings shed light on the hidden costs of white bagging, which often delays patient treatment and results in substantial drug waste. Survey respondents reported average waste associated with white bagging to be $35,000 to $652,000 per site per year, depending on the number of patients served and types of drugs administered. The study also found that white bagging drug waste imposes additional costs on practices, ranging from between $13,000 and $67,500, due to special requirements for handling and disposing of discarded products.

White bagging also presents additional expenses for patients. Across all practice respondents, 46% indicated that they have experienced instances where patients paid a copay for a regimen/dosage that was not administered due to complications from white bagging.

To read the study, CLICK HERE.

House Energy & Commerce Committee Advances the Seniors’ Access to Critical Medications Act
The House Energy & Commerce Committee on June 12 unanimously advanced a revised version of H.R. 5526, the Seniors’ Access to Critical Medications Act, which would restore oncology patients’ ability to receive prescriptions by mail or to have a family member or caregiver pick them up. 

The bill, advanced by the health subcommittee in March, extends for five years a pandemic-era waiver that allowed patients to receive prescriptions via mail, courier, or family member without centers violating the Stark Law, a physician self-referral prohibition. The revised version also requires doctors and patients to meet in person at least once annually and calls on the Centers for Medicare & Medicaid Services (CMS) to conduct a study of the waiver’s impact on utilization and costs.

The full committee’s ranking Democrat, Frank Pallone (D-NJ), who previously expressed concerns over the original iteration of the bill, said he was pleased that the full committee found a bipartisan path forward in updating the legislation. 

“While I have strong concerns with weakening the Stark Law, I believe there are limited instances in which it may be necessary for a caregiver or a family member to pick up prescription drugs for patients or for prescription drugs to be mailed, which is currently prohibited under the Stark Law. I believe this narrow Stark exception would help patients receive necessary medications but still protect Medicare beneficiaries by ensuring that provider decisions are made on the basis of clinical criteria,” Pallone said during the full committee markup. 

The Seniors’ Access to Critical Medications Act was among 12 other healthcare bills advanced to the full House during the Energy and Commerce Committee’s markup. 

To watch the markup, CLICK HERE. 

To read more, CLICK HERE. 

To read Seniors’ Access to Critical Medications Act, CLICK HERE.

MedPAC Releases June Report to Congress, Pressure Builds for Lawmakers to Act on Site Neutral Payment Reform
The Medicare Payment Advisory Commission (MedPAC) has released its most recent report to Congress, which examines several ideas for Medicare physician pay, site neutral payment, and the use of prior authorization.

MedPAC acknowledged that the current Medicare physician fee schedule is unsustainable and recommended that physicians in 2025 be paid currently allowed rates, plus 1.5% of the projected increase in the Medicare Economic Index. In a statement, the American Medical Association noted that the increase is “desperately needed,” but called on Congress to go further and pass the Strengthening Medicare for Patients and Providers Act (HR 2474).

MedPAC also noted that site-of-service payment differentials have provided an incentive for hospitals to acquire physician payments. Though the commission noted that this was partially alleviated by the Bipartisan Budget Act of 2015, it called on Congress to go further and align HOPD rates with physician office rates.

The commission’s recommendation comes as a coalition of nearly 50 organizations sent a letter to Senate Finance Committee Chair Ron Wyden and Ranking Member Mike Crapo urging them to hold a hearing on site neutral payment for drug administration.

To read the MedPAC report, CLICK HERE.

To read more, CLICK HERE.

To read the letter, CLICK HERE.

House E&C Health Subcommittee Holds Hearing on CMMI
After a recent report that the CMS Center for Medicare and Medicaid Innovation (CMMI) has increased federal spending instead of lowering it, the House Energy & Commerce Subcommittee brought in CMMI Director Liz Fowler to testify on the center and value-based care.. During a subcommittee hearing on June 13, House Energy & Commerce Committee Republicans expressed skepticism over the center’s effectiveness, directing criticism at the Cell and Gene Therapy (CGT) model aimed at reducing state Medicaid costs, and the Accelerating Clinical Evidence (ACE) model aimed at limiting CMS coverage of drugs granted accelerated FDA approval.

During the hearing, CMMI Director Elizabeth Fowler defended the center’s performance, stating she is working closely with the Food and Drug Administration (FDA) on these pricing models. Fowler defended CMMI spending, arguing that it is difficult for models to generate savings because they are voluntary and take significant time to develop and roll out.

Over Republican opposition, the committee’s ranking Democrat Anna Eshoo (D-CA) praised the center’s ability to operate without political interference. Eshoo also noted that the establishment of CMMI removed the need for congressional approval for new payment models, enhancing government flexibility in healthcare delivery.

To watch the hearing, CLICK HERE.

To read more, CLICK HERE.

Lawmakers Introduce Bipartisan Bill to Modernize Prior Authorization
A bipartisan group of lawmakers, including Senator Roger Marshall (R-KS) and Representative Suzan DelBene (D-WA) have introduced the Improving Seniors’ Timely Access to Care Act (S. 4532), which would mandate that Medicare Advantage (MA) plans to implement an electronic prior authorization system, enhance transparency reporting, and adhere to decision-making timeframes set by the Secretary of the Department of Health & Human Services.

“Prior authorization is the number one administrative burden facing physicians today across all specialties,” Marshall said in a statement. “As a physician, I understand the frustration this arbitrary process is causing healthcare practices across the country and the headaches it creates for our nurses.”

The bill unanimously passed the House last Congress, but the Congressional Budget Office (CBO) estimated its cost at $16 billion, halting its progress. The recently introduced bill has garnered broad support from hundreds of advocacy organizations, which have called on Congress to swiftly pass this bill in both chambers.

To read more, CLICK HERE.

To read the Improving Seniors’ Timely Access to Care Act, CLICK HERE.

Supreme Court Agrees to Review Medicare Disproportionate Share Hospital Payment Case
The U.S. Supreme Court has agreed to review a case, Advocate Christ Medical Center v. Becerra, that challenges how the Department of Health & Human Services (HHS) applies the formula for calculating disproportionate share hospital (DSH) payments.

In 2017, more than 200 hospitals sued HHS over its formula for calculating DSH payments, which are required payments intended to offset hospitals’ uncompensated care costs. The hospitals argued that the formula didn’t adequately account for care provided to patients eligible for Supplemental Security Income (SSI). In 2022, a U.S. District Court dismissed the hospitals’ arguments, ruling the DSH formula was consistent with Medicare statute, which details how HHS should calculate DSH payments.

In February 2024, the American Hospital Association (AHA) and five other national hospital associations urged the Supreme Court to review the case. A friend-of-the-court brief argued that HHS did not properly use patients entitled to SSI benefits in calculations, only using them if they received cash SSI payments during a hospital stay.

Oral arguments and a decision will come in the next Supreme Court term, which begins in October.

To read more, CLICK HERE.