The Price of cancer drugs has been a topic of much talk this year.
Last year, President Trump unveiled the American Patients First blueprint to decrease the costs of prescription drugs and limit out-of-pocket costs for American patients. In an effort to address drug costs, President Trump and Health and Human Services Secretary Alex Azar proposed the International Pricing Index (IPI) model, which will have an impact on the way Medicare Part-B drugs are purchased, distributed and administered to American patients.
Affordable cancer care is an important issue – with both sides of the aisle holding hearings and releasing their own drug pricing reforms. It is important that policymakers should not take hasty steps for the sake of political posturing. The recently proposed IPI inserts third-party vendors into the procurement and distribution of certain Medicare drugs which would quickly disrupt the seamless care millions of cancer patients experience as of today.
This has been tried before and failed.
In 2006, CMS launched the Competitive Acquisition Program (CAP) with the aim of reducing Medicare spending for Part-B drugs, which are complex injections or infusions – such as chemotherapy – typically administered in a doctor’s office. The voluntary program was designed for third party to compete in a bid process to supply medicines to physician offices. In theory, patients were to benefit because they would get the drugs they need at minimal cost, and Medicare would save billions of dollars. Vendors would benefit due to cost savings from beneficiaries and improved payments from Medicare.
Policymakers realized that there is a myriad of problems with the CAP model and the program was scrapped just two years later. According to MedPAC, the experiment was plagued by low physician enrollment and officials struggled to convince more than one vendor to sign up for the program. That particular vendor declined to renew its contract even though with the CAP model Medicare paid rates higher than the Average Sales Price Plus 6 percent (ASP+6) formula. Ultimately, the failure cost patients and taxpayers more than if CMS did not enact the policy at all.
Despite the previous failure, the CAP model scheme is being discussed again by officials on Capitol Hill and at CMS. Unfortunately, the current plans will significantly disrupt the drug-acquisition process and impose expensive administrative burdens on both treating physicians and other providers. Under this model, doctors and hospitals will need to set up a parallel drug acquisition system for Medicare patients. This unfunded mandate will increase costs across all the clinics and hospitals due to more employees and new technological platforms needed to manage the new drug inventory system. Despite CMS’ claims to reduce the inventory burden on community oncology practices, the proposed model will significantly increase the complexity and price of drugs. It will also be tremendously more difficult for physicians to make dosing adjustments for complex treatments at the point of care. This will make it harder for cancer patients to access the timely, personalized, and extremely high-quality care they require to effectively treat the unique needs of each patient and their disease.
It could also open patients up to Vendors’ utilization management techniques such as Step therapy, through which patients are required to take an older, less effective drug before they are authorized to receive the preferred drug an oncologist originally prescribed medications. Not only can this delay care, but current systems that use this technique are often opaque in how drugs are chosen. Using an outside vendor like in a CAP program has also led to patients receiving unsafe and even counterfeit drugs. Any CAP-like scheme also endangers patient safety by effectively shifting the responsibility of managing a patient’s personalized care away from a trained medically licensed oncologist to an outside entity. For the more than 2.0 million American patients diagnosed with cancer each year, this would be a recipe for disaster.
In addition to barriers and delays in obtaining their doctor prescribed treatment, the majority of elderly patients will not see any financial benefit such as lower costs for the patients in the United States. Americans with cancer should not be the victims of a not so successful failed trial of the system. We agree that sensible efforts should be made to decrease the patient’s cost of care, including drugs and many of our practices are voluntarily participating in several different models with multiple payer patients, including Medicare, to achieve that goal.
As a network of doctors providing community-based cancer care, we are deeply concerned with many aspects of CAP-like models, especially their potential to impede the delivery of timely, personalized cancer treatment close to home. Instead, policymakers and stakeholders should continue to work together to develop and implement voluntary, targeted and collaborative models to improve care and reduce costs, which is our nation’s most promising path toward value based care delivery.
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