WASHINGTON, D.C. — A bipartisan group of lawmakers has introduced legislation aimed at protecting patient access to cancer treatments and other complex therapies amid concerns that Medicare reimbursement cuts could force physicians to limit care options.
The “Protecting Patient Access to Cancer and Complex Therapies Act,” introduced by Congressman Greg Murphy (R-NC), a physician, alongside Congressmen Adam Gray (D-CA) and Neal Dunn (R-FL), would restore physician reimbursement for administering drugs under Medicare Part B to Average Sales Price (ASP) plus 6 percent.
Addressing Unintended Consequences of Drug Price Negotiations
The legislation comes in response to changes made by the Inflation Reduction Act (IRA), which reduced Medicare reimbursement for certain Part B drugs from ASP plus 6 percent to the Maximum Fair Price (MFP) plus 6 percent as part of the Medicare Drug Price Negotiation Program.
“Part B drug reimbursements to physicians will be crushed by consequences of the IRA’s Medicare Drug Price Negotiation Program, and patient access to life-saving drugs will dry up,” Murphy said in a statement. He warned that the cuts particularly threaten the viability of oncology, rheumatology, and neurology practices.
The proposed legislation would create an additional rebate paid by manufacturers and hold patients harmless by basing coinsurance rates off the Maximum Fair Price, ensuring patients don’t face higher out-of-pocket costs.
Rural Healthcare Providers Face Particular Challenges
Gray emphasized the impact on rural healthcare providers, stating that ensuring fair reimbursement for prescription medications would “protect rural health centers and those who keep our communities healthy.”
Dunn echoed these concerns, noting that fair reimbursement would “improve patient outcomes and protect rural health centers in Northwest Florida and across the country.”
Healthcare Groups Voice Support
Several healthcare organizations have endorsed the legislation, citing concerns about maintaining patient access to specialized treatments.
Dr. Scott Sellinger, President of the Large Urology Group Practice Association (LUGPA), said the legislation would ensure that “cancer patients and those with complex illnesses maintain access to their physician-administered drugs.”
Doug Ghertner, President of the Infusion Providers Alliance, praised the lawmakers’ leadership, noting that the legislation addresses “an unintended consequence of the Inflation Reduction Act” that would significantly reduce physician reimbursement while attempting to lower drug prices.
Significant Financial Impact Projected
According to the legislation’s supporters, reimbursement for cancer, neurological, and autoimmune patient treatments could decrease by $56.3 billion over 10 years due to the current changes under the IRA.
Ted Okon, Executive Director of the Community Oncology Alliance, described the bill as a “technical fix” that would alleviate reimbursement cuts and administrative burdens threatening seniors’ access to cancer care and treatments for other serious diseases.
Balancing Cost Savings with Patient Access
The legislation aims to strike a balance between achieving the IRA’s goal of reducing drug costs while maintaining patient access to essential treatments. Supporters argue that the current reimbursement structure could force physicians to stop offering certain treatments, particularly in independent practices and rural settings where margins are already thin.
The bill represents a bipartisan effort to address what lawmakers describe as an unintended consequence of healthcare cost reduction efforts, ensuring that attempts to lower drug prices don’t inadvertently limit patient access to life-saving treatments.
