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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US Oncology | 10101 Woodloch Forest | The Woodlands, TX 77380

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Health Policy Report - July 29, 2015
  • • Ways & Means Committee Examines Hospital Site Neutral Payment Reforms
  • • More than 100 Oncologists Call for Lower Drug Prices in Letter to Policymakers
  • • Senator Grassley Calls for 340B Hearings for Unintended Consequences
  • • Medicare Depletion Date Expected at 2030

      Health Policy Report - July 15, 2015
      • • CMS Releases Proposed Rule for 2016 Medicare Physician Fee Schedule
      • • U.S. House Passes 21st Century Cures Legislation
      • • GAO Study: Eliminate Incentives for Expensive Drugs at 340B Hospitals
      • • CMS Helps Physicians Transition to ICD-10 with 12-Month Safe Harbor Period, Ombudsman, and Training

          Health Policy Report - June 30, 2015
          • • Bipartisan Bill to Equalize Medicare Payments for Cancer Care Introduced in the House
          • • GOP Doctors Caucus Seeks to Preserve Medicare Self-Referral Exception
          • • U.S. Supreme Court Upholds Insurance Subsidies in King v. Burwell

              Health Policy Report - June 3, 2015
              • • Federal Government Releases 2013 Medicare Billing Data
              • • Senate Finance Leaders to Explore Improved Delivery of Chronic Care
              • •NIH Announces Nationwide Precision Medicine Trial for Cancer Patients
              • • Senate Finance Committee Examples Medicare Audit and Appeals Reforms

                  Health Policy Report - May 21, 2015
                  • • Energy & Commerce Committee Releases Updated 21st Century Cures Legislation; 340B Reform Measure Not Included
                  • • Connecticut Senate Bill Proposes Site-Neutral Payment Reforms
                  • • Petition Calls for Expanded Copay Assistance Programs, Patient Access to Cancer Care
                  • • IMS Institute Unveils Global Oncology Trend Report
                  • • CDC Report: Cancer Screening Rates on Decline

                      Health Policy Report - May 6, 2015
                      • • TAKE ACTION: Ask Lawmakers to Oppose Proposal to Extend Sequestration Cuts
                      • • President Obama Signs Historic SGR Reform Legislation
                      • • CMS: Small Volume of Medicare Claims will be Impacted by SGR, Processed at Reduced Rate
                      • • MedPAC Analyzes Bundling Oncology Services
                      • • CMS Proposes Changes to EHR Incentive Program
                      • • April Health Affairs Focuses on Cancer Care
                      • • USPSTF Issues New Draft Recommendations on Breast Cancer Screening

                          Health Policy Report - April 23, 2015
                          • • TAKE ACTION: Ask Lawmakers to Oppose Proposal to Extend Sequestration Cuts
                          • • President Obama Signs Historic SGR Reform Legislation
                          • • CMS: Small Volume of Medicare Claims will be Impacted by SGR, Processed at Reduced Rate
                          • • MedPAC Analyzes Bundling Oncology Services
                          • • CMS Proposes Changes to EHR Incentive Program
                          • • April Health Affairs Focuses on Cancer Care
                          • • USPSTF Issues New Draft Recommendations on Breast Cancer Screening

                              Health Policy Report - April 1, 2015
                              • • US House Passes Bipartisan Bill to Repeal SGR
                              • • Senate, House Pass Budget Resolutions
                              • • House Energy and Commerce Committee Examines 340B Program
                              • • New Study Refutes Claims that Self-Referral Encourages Inappropriate Utilization or Increased Medicare Spending
                              • • GAO Analyzes Medicare Payments to Certain Cancer Hospitals

                                  Health Policy Report - March 20, 2015
                                  • • Congress Introduces Bipartisan Bill to Repeal SGR
                                  • • MedPAC Once Again Recommends Site-Neutral Payment Reform
                                  • • Medicare to Publish Physician-Payment Data Next Month
                                  • • U.S. Supreme Court Examines Health Insurance Subsidies in King v. Burwell
                                  • • HHS Unveils Next Generation Accountable Care Organization Model
                                  • • CDC Unveils Report on Invasive Cancer Incidence and Survival
                                  • • Maryland Legislature Considers Law Allowing Integrated Cancer Care
                                  • • CMS Considers Expansion of Coverage for PET Cancer Scans

                                      Health Policy Report - February 26, 2015
                                      • • The US Oncology Network’s Dr. Barry Brooks Pens Op-Ed Highlighting Need for Site-Neutral Medicare Payment Reform
                                      • • HHS Unveils New Payment Model for Cancer Care
                                      • • Prompt Pay Discount Legislation Introduced in U.S. House
                                      • • CMS Approves Medicare Coverage for Lung Cancer Screening
                                      • • CBO Releases Higher SGR Replacement Cost Estimate
                                      • • Lawmakers Debate Preparedness for ICD-10 Transition

                                          Health Policy Report - February 5, 2015
                                          • • President Obama Endorses Site-Neutral Payment Policies in FY2016 Budget Proposal
                                          • • Obama Administration Releases Details of Precision Medicine Initiative
                                          • • 21st Century Cures Initiative Enters Legislative Phase
                                          • • HHS Unveils Plan to Revamp Medicare Payments
                                          • • HHS Asks DC Court To Drop 340B Orphan Drug Lawsuit

                                              Health Policy Report - January 23, 2015
                                              • • The US Oncology Network Joins New Alliance for Site-Neutral Payment Reform
                                              • • Energy and Commerce Committee Hearing Focuses on Future of SGR
                                              • • Obama Sets an Ambitious Agenda In State of the Union, Healthcare Not A Focus
                                              • • MedPAC Discusses Site-Neutral Payments, Hospital Reimbursement, and Physician Payment Rates

                                                  Health Policy Report - January 7, 2015
                                                  • • 114th Congress Convenes, Republicans Control Both Chambers of Congress
                                                  • • 2014 Healthcare Policy Milestones & Trends
                                                  • • Congress Raises Concerns about 340B
                                                  • • MedPAC Shows Continued Support for Payment Parity
                                                  • • Cancer Death Rates in U.S. Continue to Decline

                                                      Health Policy Report - December 10, 2014
                                                      • • Report: 340B Sales to Rise
                                                      • • National Media Outlets Examine Impact of Higher Hospital Costs on Cancer Care
                                                      • • Healthcare Spending Growth Slowed in 2013
                                                      • •U.S. House of Representatives Passes ABLE Act
                                                      • • CMS Proposes New ACO Regulation

                                                          Health Policy Report - November 20, 2014
                                                          • • MedPAC Examines Part B Drug Payment Policy
                                                          • • HRSA Pulls Back 340B 'Mega Rule’
                                                          • • Supreme Court to Hear Affordable Care Act Subsidies Case
                                                          • • Lawmakers, Physician Groups Seek SGR Reform in Lame Duck Session
                                                          • • CMS Proposed Lung Cancer Screening Coverage for High-Risk Beneficiaries
                                                          • • VA Reimbursement Rule Has Providers Fearing Slow Payment

                                                              Health Policy Report - November 4, 2014
                                                              • • CMS Releases Final Rule for 2015 Medicare Physician Fee Schedule
                                                              • • HRSA Asks Drug Manufacturers to Refund 340B Overcharges
                                                              • • Medical Costs Up to 20% Higher at Hospital-Owned Physician Groups, Study Finds
                                                              • • Supreme Court Not Taking Up Insurance Subsidies Lawsuit Yet
                                                              • • Simpler Home Test for Colon Cancer Offered

                                                                  Health Policy Report - October 22, 2014
                                                                  • • New COA Report Finds 82% Increase in Cancer Clinic Closings Since 2010
                                                                  • • PhRMA Files Suit Challenging HHS Orphan Drug Regulation
                                                                  • • Aunt Minnie Op-Ed: Payment parity in radiation therapy best serves cancer patients
                                                                  • • JAMA Articles Illustrate Division Over Lung Cancer Screening
                                                                  • • AMA Sends Blueprint to Strengthen the Meaningful Use Program to CMS

                                                                      Health Policy Report - October 8, 2014
                                                                      • • More than 160 Members of Congress Weigh in with CMS on Radiation Oncology Cuts
                                                                      • • Congress Breaks for Mid-Term Election Campaigning; Lame-Duck Session Approaching
                                                                      • • Health Affairs Report Findings Reinforce 340B Program Abuse Concerns
                                                                      • • Physician Groups Warn New Open Payments Site Contains Errors, Lack Accuracy
                                                                      • • Role of RUC in Assigning Medicare Payments Called into Question

                                                                          Health Policy Report - September 26, 2014
                                                                          • • Republican Lawmakers Call for Increased Transparency in Rule Making Process
                                                                          • • MedPAC Weighs Least-Costly Alternative Approaches To Control Part B Drug Prices
                                                                          • • CMS Releases Medicare ACO and Shared Savings Program Results
                                                                          • • Stakeholders Concerned Sunshine Act Data Release Lacks Needed Context and Background Information
                                                                          • • Bipartisan Bill Introduced in House to Extend Deadline to Show Meaningful Use of Electronic Health Records

                                                                              Health Policy Report - September 10, 2014
                                                                              • • Take Action Today! Encourage Congress to Stand Up Against Proposed Radiation Oncology Cuts
                                                                              • • The US Oncology Network Submits Formal Comments to CMS on Proposed Payment Policy Revisions
                                                                              • • Bipartisan House Energy & Commerce Health Subcommittee Leaders Ask CMS to Maintain Status Quo on Radiation Therapy Payments
                                                                              • • Open Payments Site Experiences Delays; Physicians Concerned
                                                                              • • District Court Upholds New Interpretive HRSA Rule on 340B Orphan Drug Exclusions
                                                                              • • New CMS Report Predicts Positive Trends in Healthcare Spending

                                                                                  Health Policy Report - August 19, 2014
                                                                                  • • CMS Releases Potential Innovative Oncology Payment Model
                                                                                  • • New Veteran Affairs Bill Expands Private Practice Services to Veterans
                                                                                  • • Physician Groups Concerned Open Payments Dispute Process Flawed
                                                                                  • • RAND Analysis Recommends Review of 340B Program Processes
                                                                                  • • 310,000 Enrollees To Lose Healthcare Coverage If Citizenship Not Verified

                                                                                      Health Policy Report - August 5, 2014
                                                                                      • • New Medicare Report: Improved Financial Outlook for Medicare Trust Fund
                                                                                      • • Bipartisan Lawmakers Express Support For 340B Program
                                                                                      • • The US Oncology Network Joins Cancer Care Advocates in Submitting USP Chapter <800> Comments
                                                                                      • • E&C Health Subcommittee Convenes Markup on Important Healthcare Legislation

                                                                                          Health Policy Report - July 23, 2014
                                                                                          • • Two U.S. Appeals Courts Issue Contradictory ACA Subsidies Rulings
                                                                                          • • HRSA Issues Interpretive Rule Maintaining 340B Orphan Drug Exclusion
                                                                                          • • CMS Proposes Eliminating CME Exclusion from Open Payments Program
                                                                                          • • Colon Cancer Care Advocates Urge Congress to Eliminate Colonoscopy Copay
                                                                                          • • Health Affairs Examines Future of “Big Data” in US Healthcare System

                                                                                              Health Policy Report - July 9, 2014
                                                                                              • • CMS Releases Proposed Rule Setting 2015 Medicare Physician Fee Schedule Payment Rates
                                                                                              • • HRSA Releases 340B Auditing Process Changes
                                                                                              • • Study Finds Cost of Care for Common Patient Services Doubles in HOPD
                                                                                              • • Open Payments System Registration for Physicians Begins Mid-Month

                                                                                                  Health Policy Report - June 18, 2014
                                                                                                  • • New Study Finds Shift To Hospital Setting Drives Up Cancer Costs
                                                                                                  • • Alliance for Integrity and Reform of 340B Hosts National Leadership Summit to Discuss 340B Reforms
                                                                                                  • • MedPAC Expands Support of Site Neutral Payments
                                                                                                  • • Large Bipartisan Group of Lawmakers Urge Medicare Decision on Low-Dose CT Scans For Lung Cancer Screening

                                                                                                      Health Policy Report - June 4, 2014
                                                                                                      • • The US Oncology Network’s Barry Brooks Testifies Before House Energy & Commerce Health Subcommittee on Site-Neutral Medicare Payment Reform
                                                                                                      • • Court Decision Calls HRSA 340B Rule-Making Authority Into Question
                                                                                                      • • New Study Examines 340B Hospital Acquisitions of Physician-Based Oncology Practices
                                                                                                      • • CMS Issues Proposed Rule on “Meaningful Use” Requirements
                                                                                                      • • Senators Urge Medicare to Cover Lung Cancer Test
                                                                                                      • • Burwell Vote Likely this Week

                                                                                                          Health Policy Report - May 14, 2014
                                                                                                          • • IMS Institute: Higher Cancer Costs Due to Shift To Hospital Outpatient Facilities
                                                                                                          • • Stanford University Study Finds Hospital Ownership of Physician Practices Leads to Higher Prices
                                                                                                          • • CMS Confirms One-Year Delay of ICD-10 Code Transition
                                                                                                          • • Senate Holds Confirmation Hearings for HHS Secretary Nominee Burwell
                                                                                                          • • HHS: Health Insurance Marketplace Enrollment Exceeds 8 Million Americans

                                                                                                              Health Policy Report - April 30, 2014
                                                                                                              • • MARK YOUR CALENDAR! Virtual Hill Days May 7 & 8
                                                                                                              • • Jonathan Blum Announces CMS Departure
                                                                                                              • • Burwell Hearing Set
                                                                                                              • • Healthcare Coalition Urges CMS to Set Date for Implementation of ICD-10 Codes
                                                                                                              • • New Online Tool Available to Search Physician Payment Data

                                                                                                                  Health Policy Report - April 16, 2014
                                                                                                                  • • CMS Announces Release of Physician Payment Information
                                                                                                                  • • Narrow Insurance Networks Could Threaten Patient Access to Specialized Cancer Care Centers
                                                                                                                  • • HHS Secretary Kathleen Sebelius Steps Down
                                                                                                                  • • House Passes Ryan Budget Resolution; Action Not Likely in Senate
                                                                                                                  • • CBO Releases Updated Budget Projections for SGR Patch

                                                                                                                      Health Policy Report - April 1, 2014
                                                                                                                      • • The US Oncology Network Joins Community Oncology Alliance in Urging Congressional Leaders to Address Cancer Care Crisis
                                                                                                                      • • Congress Moves to Avert Medicare Physician Payment Cuts
                                                                                                                      • • New Analysis Shows Many 340B Hospitals Provide Minimal Charity Care
                                                                                                                      • • Obamacare Open Enrollment Period Closes

                                                                                                                          Health Policy Report - March 20, 2014
                                                                                                                          • • House Passes SGR Repeal with Delay of ACA Individual Mandate
                                                                                                                          • • Coalition for Patient Centered Imaging Urges Congress to Preserve Patient Access to Integrated Care
                                                                                                                          • • New Report Finds Overall Cancer Cases on the Rise
                                                                                                                          • • HHS Updates HIPAA Regulations
                                                                                                                          • • Colon Cancer Rates Drop by 30 Percent

                                                                                                                              Health Policy Report - March 6, 2014
                                                                                                                              • • Virginia Cancer Specialists Featured in Fox New Special Report
                                                                                                                              • • Op-Ed Highlights Importance of Rational Payments for Cancer Care
                                                                                                                              • • President Obama Releases 2015 Budget Proposal
                                                                                                                              • • CBO Releases Score for SGR Bill
                                                                                                                              • • Quality Data Added to CMS’ Physician Compare Website
                                                                                                                              • • World Health Organization: Cancer Cases on the Rise

                                                                                                                                  Health Policy Report - February 20, 2014
                                                                                                                                  • • The US Oncology Network’s Dr. Barry Brooks Calls for Equalization of Medicare Payments in The Hill
                                                                                                                                  • • OIG Releases Report on 340B Drug Discount Program
                                                                                                                                  • • Congress Votes to Extend Sequestration
                                                                                                                                  • • Lancet Oncology Paper Calls on Oncology Community to Recognize Costs, Limitations of Cancer Treatments
                                                                                                                                  • • Insurance Exchange Enrollment Climbs to 3.3 Million
                                                                                                                                  • • CBO Report Finds Slower Medicare Spending Growth

                                                                                                                                      Health Policy Report - February 6, 2014
                                                                                                                                      • • Lawmakers Reach SGR Deal with Five Years of 0.5 Percent Payment Hikes
                                                                                                                                      • • President Obama Delivers State of the Union Address
                                                                                                                                      • • Congressman Henry Waxman Announces Retirement
                                                                                                                                      • • CMS Report Finds ACOs Are Lowering Spending Growth
                                                                                                                                      • • CMMI Technical Expert Panel for Oncology Examines Alternative Payment Models
                                                                                                                                      • • COA and ASCO Release Principles for Payment System Reform

                                                                                                                                          Health Policy Report - January 23, 2014
                                                                                                                                          • • MedPAC Recommends Aligning Payments Across Care Settings
                                                                                                                                          • • CMS Announces Release of Physician Payment Data
                                                                                                                                          • • Congress Approves $1.1 Trillion Spending Bill
                                                                                                                                          • • New Study: IMRT Improved Survival Rates in Head and Neck Cancer Patients

                                                                                                                                              Health Policy Report - January 7, 2014
                                                                                                                                              • • Congress Returns to Washington; Budget Deal Needed Before January 16 Deadline
                                                                                                                                              • • Senate Finance and Ways and Means Committees Mark Up Permanent SGR Replacement Bill
                                                                                                                                              • • Obamacare Enrollment Swells in December
                                                                                                                                              • • New Obama Administration Report Claims Slow Healthcare Spending Growth
                                                                                                                                              • • Final USPSTF Screening Recommendations for Lung Cancer Released





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