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House Bill to Improve Accuracy of Medicare Reimbursement Introduced: Members of Congress Seek to Stem Growing Healthcare Coverage Shortfalls, Community Oncology Alliance Advocates for Swift Passage of Bill
Date:3/10/2009

WASHINGTON, March 10 /PRNewswire-USNewswire/ -- Representatives Gene Green (D-TX), Ed Whitfield (R-KY), Mike Ross (D-AR), Ed Towns (D-NY), Diana DeGette (D-CO), Mike Rogers (R-MI), Betty Sutton (D-OH), Bart Gordon (D-TN), Lee Terry (R-NE) and Ralph Hall (R-TX) today introduced H.R. 1392.

This bill will amend title XVIII of the Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program by excluding customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). These discounts artificially reduce Medicare Part B drug reimbursement rates for community oncology clinics, jeopardizing the viability of these providers. The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs.

"This bipartisan bill is imperative for millions of Americans across the nation to have access to treatment at community oncology clinics and to the life-saving medications they need," said U.S. Rep. Gene Green (D-TX).

Excluding distributor prompt pay discounts from the ASP methodology is consistent with existing policy and will create greater uniformity among federal healthcare programs, as these terms already are excluded from the Medicaid Average Manufacturer Price (AMP) methodology.

The U.S. has the best cancer care delivery system in the world, in which 84 percent of Americans receive quality, compassionate care in community cancer clinics. However, the cancer care delivery system is now in first-stage crisis because Medicare has substantially cut payment for cancer drugs and essential services.

Community cancer clinics have had to close satellite facilities and cut staff. Smaller clinics are struggling to operate and more will close. Patients with insufficient or no insurance, especially seniors covered by Medicare, are increasingly being sent elsewhere for treatment and some patients are actually foregoing treatment. The crisis will deepen as demand for cancer care is now starting to exceed the supply of oncologists during the next 11 years, when we will be short an oncologist for every 1 in 3 cancer patients.

"This is a national problem that is affecting the delivery of cancer care treatment to our most vulnerable patients," said U.S. Representative Ed Whitfield (R-KY). "It is critical that we address this issue because these cuts to the Medicare reimbursements are having an adverse impact to physicians, related practitioners and their patients in all our communities."

"This bipartisan bill will help people with cancer receive treatment in their communities. It's important that we act now to help people who need these life-saving medications," said U.S. Representative Diana DeGette (D-CO), Vice Chair of the Committee on Energy and Commerce, which has jurisdiction over health care policy.

The problem not only centers on payments for cancer drugs, but also on essential services provided to cancer patients, such as treatment planning, which are not reimbursed by Medicare.

"On behalf of community oncology clinics, I thank Congressmen Green and Whitfield and their colleagues for their leadership. The introduction of this bill is a welcome and needed first step in supporting community cancer clinics," said Patrick Cobb, M.D., president of the Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana. "However, more has to be done because clinics provide cancer care to their patients that is not reimbursed by Medicare."

About Community Oncology Alliance (COA)

COA is a non-profit organization dedicated solely to community oncology. COA was founded by community oncology to advocate for patients and providers in the community oncology setting, where 84 percent of Americans with cancer are treated. In only six years of existence, COA has mobilized community oncology to become more politically active, and increased awareness on Capitol Hill about the community cancer care delivery system. Additionally, COA has brought together community oncology practices from across the country to share information in order to enhance the effectiveness and efficiency of the cancer care they provide to their patients.

Currently, COA is working with the Congress in proving proactive solutions designed to protect the viability of the nation's cancer care delivery system and patients' access to quality, affordable cancer care. The cancer death rate in the U.S. has declined due to earlier detection, the quality of treatment, and the accessibility of cancer care. However, according to the American Cancer Society, men still have an approximately one in two lifetime risk of developing cancer, with a risk of one in three for women. For more information, please visit www.communityoncology.org.


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SOURCE Community Oncology Alliance
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