Oncologists say Medicare plans may hurt cancer care

Hundreds of oncologists, cancer patients and supporters will head to the U.S. Congress on Wednesday to warn lawmakers their Medicare prescription drug plans may threaten seniors’ access to cancer treatments.

The House and Senate bills to provide prescription drug coverage to millions of seniors on Medicare would cut more than $500 million, or about 30%, annually from cancer care, according to the American Society of Clinical Oncology. “That kind of cut cannot be sustained without substantial turbulence and disruption of care,” said Deborah Kamin, ASCO’s senior director for cancer policy and clinical affairs. The bills, which passed the House and Senate last month, offer differing plans for changing Medicare chemotherapy reimbursement. Lawmakers must work out the differences and pass a final version before it can go to the president to be signed into law. The reimbursement problem stems from the way Medicare pays for chemotherapy and other injected drugs the program currently covers. A report by Congress’ General Accounting Office found Medicare, the government health insurance for the elderly and disabled, overpaid $1 billion for certain medicines in 2000. Critics say drug makers manipulated the system to entice doctors to prescribe their products. Currently, doctors who give chemotherapy in their offices purchase the medicines and are reimbursed for 95% of a drug’s “average wholesale price,” or AWP, a number drug makers report to the government. Critics say AWP translates to “ain’t what’s paid,” charging that drug makers give discounts to doctors and report a higher price to the government. Drug makers say they obey the law. Cancer specialists, while admitting the current system has flaws, argue the difference compensates for under-payment for costs related to chemotherapy, such as the nurses who give the infusions, equipment and patient counseling. Supporters of proposed changes say they will cut out abuse while adequately supporting cancer care. The House plan “is a fair compromise. It will prevent extraordinary inflated co-payments while at the same time ensuring that cancer patients and others will have access to treatment,” said Ken Johnson, a spokesman for House Energy and Commerce Committee Chairman Billy Tauzin. The House bill would change to an “average sales price” determined by the government plus 12%. The Senate plan would pay 85% of the AWP. The bills also include higher payments to oncologists to cover expenses. ASCO expects more than 400 oncologists, nurses, cancer patients and other supporters to visit lawmakers offices’ on Wednesday to press for more generous reimbursement in the final Medicare bill. Under the current proposals, “There would be really no way that many physicians could provide all the essential cancer care services,” Dr. Margaret Tempero, ASCO’s president, said. An ASCO survey of more than 900 of its physician members found 19% said they would stop treating Medicare patients if current proposals become law, while 53% said they would limit Medicare patients. Seventy-three percent said they would send chemotherapy patients to a hospital rather than treating them in an office setting. That option may be costlier and less convenient for patients, Tempero said.(Source: Reuters Health: Lisa Richwine: July 15, 2003: Oncolink)