COA Physician Survey: Medicare Part B Proposals Will Harm Patients, Increase Costs and Bureaucracy

WASHINGTON, May 16, 2018 /PRNewswire-USNewswire/ -- A survey released today by the Community Oncology Alliance (COA) finds that the majority of physicians are very concerned that recent proposals to reform the Medicare Part B program will have a negative impact on patient care.

Scarred by firsthand experience dealing with the negative patient impact of bureaucratic Pharmacy Benefit Manager (PBM) middlemen in the Part D program, the surveyed physicians fear recently proposed changes to the Medicare Part B program will reduce care choices, drive up costs, increase administrative burdens, and decrease physician autonomy.

"Cancer patients have endured decades of health 'reform' and big ideas from Washington that have backfired, making it more difficult and much more expensive for them to receive care. Policymakers must be careful that patients do not have to suffer through more half-baked, poorly conceived changes," said Jeffrey Vacirca, MD, FACP, CEO of NY Cancer Specialists and president of COA. "We must carefully think about and evaluate the impact of changes to our complex health care system and discuss them with patients and practicing physicians. If we are not careful, Washington could set the cancer care system back significantly, harming patients, and increasing costs."

COA commissioned the survey to gather physician perspectives on two specific proposals put forth by the Medicare Payment Advisory Commission (MedPAC) which became a reality in President Donald Trump's blueprint to lower drug prices and reduce out-of-pocket costs released last week. Opinions on the revamped Competitive Acquisition Program (CAP), also referred to by MedPAC as the "Drug Value Program" (DVP), in which select private vendors would negotiate drug prices with manufacturers and a proposal to shift prescription drugs currently paid for under the Medicare Part B program into the Medicare Part D program were surveyed.

The web-based survey of 100 oncologists/hematologists and 50 rheumatologists found that providers were overwhelmingly concerned that the types of reforms being proposed would interfere with their ability to treat patients and provide timely, affordable access to care. Specifically, the survey found:

Physician Perspectives on a Competitive Acquisition Program (CAP) or Drug Value Program (DVP):

• 88% of providers believe a CAP or DVP program would take care decisions away from the person in the best position to make that decision;
• More than 87% believe it would limit their ability to provide the best care to patients;
• 75% of providers believe it would increase the administrative burden for their practices; and
• 61% of providers believe it would diminish their prescribing autonomy and ability to tailor prescriptions to the patient.

Physician Perspectives on Shifting Drugs from Medicare Part B to Part D:

• 85% of providers believe moving Part B drugs to Part D will create affordability issues for patients;
• 89% of providers believe it could delay treatment access;
• 92% believe it would reduce treatment choices; and
• 93% of providers believe it will increase the administrative burden.

COA supports the Administration's goal to lower the cost of prescription drugs. The status quo is no longer acceptable, and we must work together to get a handle on the price and cost of drugs and overall health care spending. Community oncologists, oncology nurses, administrators, and other practice professionals are the front-line providers of care to the majority of Americans with cancer. They understand the enormous problems created by escalating health care costs. Ensuring patients can afford and access life-saving cancer therapies is a top priority for community oncology.  

However, history has shown that even well-intended policymaking can backfire, resulting in increased costs, less access to care, and harm to patients. This has been particularly true in cancer care, where Americans today are facing higher costs that can be tied directly to the unintended consequences of federal policymaking. COA is particularly concerned about sweeping proposals for changes to the Medicare program and the impact that rushing to implement those would have on patients. The Trump Administration should be seeking to reduce the role and influence of middlemen who come between patients and their providers, not increase it as proposed. Introducing third-party, PBM-type entities to Medicare Part B, or shifting some prescription drugs currently paid for under Medicare Part B to the Part D program that is dominated by PBMs would be a fatal mistake.

"Faulty government policy on Medicare Part B has resulted in massive consolidation of our nation's cancer care delivery system as documented by cancer clinic closings and care moving into the much more expensive hospital setting. The result has been access problems and higher costs for Americans with cancer, especially seniors. And it's no surprise that health care spending has steadily increased with this consolidation," said Ted Okon, executive director of COA. "I am shocked that this Administration is going to throw fuel on this fire by moving Part B drugs into Part D and by bringing more middlemen in to so-called 'negotiate' drug prices. History clearly shows that this will result in cancer patients having more difficulty getting treatment and paying more for it, including higher drug list prices. This will put the nation's cancer care delivery system in even greater peril."

While much of the debate over PBMs focuses on economics, there is often not enough discussion about the impact PBMs have on patients. The sad fact is that these middlemen often make more money by delaying or denying patients access to necessary medications. COA has documented real-life patient horror stories from practices and physicians about patients battling cancer who have suffered at the hands of PBMs due to delayed coverage decisions, denial of coverage, arguments with physicians over proper treatment, and failure to receive medications in a timely manner. These concerns are clearly reflected in the results of the survey.

COA and community oncology practices are actively working on solutions to high drug prices and the cost of cancer care by relying on the real-world medical experiences of providers on the front lines of cancer care to craft viable, truly patient-centric solutions. This includes providing practices with the support that they need to succeed in the Centers for Medicare & Medicaid Innovation Oncology Care Model (OCM), as well as by developing the OCM 2.0, a universal model of oncology payment reform that includes value-based payments for drugs and services.

The Community Oncology Alliance (COA) is a non-profit organization dedicated solely to preserving and protecting access to community cancer care, where the majority of Americans with cancer are treated. COA leads community cancer clinics in navigating an increasingly challenging environment to provide efficiencies, patient advocacy, and proactive solutions to Congress and policymakers. Learn more about COA at www.CommunityOncology.org.

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SOURCE Community Oncology Alliance