US Oncology Government Relations Action Alert 
Help Ensure Accurate Reimbursement for Cancer Drugs

Encourage Support for Prompt Pay Legislation

While Congress gears up for another election year, it is important to remind them of the disparity in cancer care reimbursement.  In 2003, Congress established the Average Sales Price (ASP) as the reimbursement metric for drugs reimbursed under Medicare Part B. In the 2006, the Centers for Medicare and Medicaid Services (CMS) interpreted the definition of ASP to include prompt pay discounts from manufacturers to wholesalers in the calculation of the payment to the physician, artificially lowering this reimbursement by 1.5% for drug purchases.  

When the 1.5% prompt pay discount reduction is combined with other reductions in cancer drug reimbursement, including the 6-month lag in pricing data of ~ 1% and average bad debt losses of ~ 5%, reimbursement for many cancer drugs remain extremely low and even underwater for many of these cancer drugs. Ultimately these factors have a negative effect on cancer care practices and threaten access for cancer patients across the nation.

We urge you to make your voices heard on this critical issue. Take a few moments to make a phone call (talking points provided) or send an email (draft provided) to explain to your Members of Congress the seriousness of this disparity in Medicare reimbursement.  Encourage them to cosponsor HR 905 (Whitfield/Green) and S 733 (Stabenow/Roberts) to ensure more appropriate payment for drugs and biologics under Medicare Part B.

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Health Policy Report - August 19, 2014




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