Anti-cancer drugs cut by Medicare
By Bob Cusack
Cancer doctors see a coordinated effort by the White House and Congress to siphon
federal money from cancer treatment and use it for prescription drugs currently not
covered by Medicare.
The Bush administration’s unexpected move to cut Medicare payments for cancer
drugs has left some oncologists feeling they are being targeted unfairly.
In an act that caught many healthcare experts off guard, the Centers for Medicare
and Medicaid Services (CMS) indicated last week that it will soon issue a new
regulation that will propose cutting Medicare payments for cancer drugs. The
proposed change of policy was first reported in The New York Times.
Medicare does not pay for most outpatient prescription drugs but does cover some
under certain circumstances, such as drugs used with organ transplantation and
chemotherapy.
This comes at a time when Congress has made headway on fixing the
reimbursement system for cancer drugs. Government auditors have said the
current policy has cheated taxpayers for years.
As part of their respective Medicare reform bills, the House and Senate have passed
legislation that would lower payments for cancer drugs. Oncologists, however, claim
that the legislation would hamper patient access to care because it would lower their
Medicare reimbursements as well.
CMS Administrator Tom Scully has vowed repeatedly to fix the payment system if
Congress doesn’t act.
Some healthcare experts and political observers view the new regulation as a
maneuver to apply pressure on Congress to pass legislation this year. Others say it’s
a pressure move on oncology groups to cut a deal with Congress.
A CMS spokesperson said the administration wants to make sure the payment
system is revamped quickly, adding that Medicare patients will continue to pay
higher co-pays until the reimbursement formula is recalculated.
Government auditors have concluded that Medicare overpayments for cancer and
other drugs cost the taxpayers more than $1.6 billion a year.
Now that the administration is poised to issue its regulation, there are some in the
oncology community who feel they are being singled out.
In an Aug. 11 e-mail that was widely circulated, Gregory Patton of U.S. Oncology, a
medical network of cancer physicians, said: “Not to be too paranoid, but a pattern is
emerging…it looks as if the intent is to redistribute substantial Federal funding now
consumed by cancer care to other more politically expedient and visible uses such as
prescription drugs. Scully’s obvious strategy is to impose changes administratively
rather than through the less controllable, less certain, and much slower legislative
meat grinder. We in the oncology community are high profile targets.â€
Patton said that “it’s an overstatement to view this as a classic struggle of good vs.
evil, but it does seem to boil down to a basic test of pure political muscle. This is the
arena where this battle will be won.â€
He adds in the e-mail that “mobilizing our patients through appropriate
organizations†is essential to defeating the proposed cuts.
Patton, who has lobbied on Capitol Hill on the issue, said he was commenting as one
practicing physician and not on behalf of U.S. Oncology. He said he may have been
too hasty in his criticism because after further review, Patton believes CMS’s plan is
not as bad as he originally thought. However, it has more negatives than positives,
he added. If outpatient chemotherapy is not viable because of government cuts,
there is no backup for cancer patients, Patton stressed.
The prospects of Medicare reform legislation becoming law are unclear, and the
cancer drug issue is just one of many that House and Senate officials will tackle in
the conference.
The cancer drug issue has been no stranger to controversy. In a June meeting,
oncology lobbyists clashed with top lawmakers on the subject. Several lawmakers,
including House Ways and Means Committee Chairman Bill Thomas (R-Calif.),
objected strongly to the advertising campaign that the oncologists had launched.
Congressional aides expect that oncology groups will lobby Congress to block the
administration’s new regulation and continue to press for legislation sponsored by
Reps. Charlie Norwood (R-Ga.) and Lois Capps (D-Calif.). That bill, oncologists say,
would lower Medicare payments for cancer drugs but not hamper patient access to
care.
But key GOP lawmakers have rejected the Norwood-Capps legislation as insufficient.
Aides say that oncology lobbyists wrote the bill themselves.
In another twist, a former Medicare spokeswoman has spoken out against the
administration’s regulation. In a letter to The New York Times, Joyce Winslow
suggested the new rule would deliver “a belly punch to patients fighting for their
lives.â€
CMS is not planning to respond to the letter, which will likely be used as political
ammunition to try to thwart the proposed cuts.
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