New Medicare Drug Rule Potential Impact on Cancer Patients

September 17, 2020
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Background
The White House recently released the Executive Order on Lowering Drug Prices by Putting America First. This Executive Order (EO) would create demonstration projects across the country through the Centers for Medicare and Medicaid Innovation at the Department of Health and Human Services (HHS) to test a requirement that Medicare pay the same price for prescription drugs as other countries (with comparable gross domestic product otherwise known an indicator of a country’s economic health). This includes all drugs, both Medicare Part B (typically infused in a physician’s office such as chemotherapy or immunotherapy) and Part D (prescriptions typically sold at the pharmacy counter like oral medications).

CSC strongly supports, and has long advocated for, policies that improve access and affordability for cancer patients. Patients should have the right to determine the most appropriate therapies by engaging in a shared decision-making process with their providers.

Process
This EO leaves several unanswered questions. First, there have been public reports that the White House could bypass traditional rulemaking for the Part B portion which would take immediate effect. It remains unclear how or when the related Part D proposal might be issued. Changes that will impact patients deserve to be made transparently and with ample opportunity for all stakeholders to engage in the process and to make their voices heard.

Access to Innovation
It is also unclear if this EO will impact the ability of America’s cancer patients to access appropriate, innovative therapies. Changes to the nation’s largest health insurance program, which covers the majority of cancer patients (those over the age of 65), must be undertaken with caution and with an understanding of the full implications on how it will impact patients in America, as our health care system differs from systems in other countries. Further, changes to reimbursement models must ensure that ongoing innovation is not impacted.

Next Steps
CSC looks forward to participating in all opportunities to engage on this issue and will provide updated information to patients and advocates regarding opportunities to learn more and stay involved.