09/05/2018

Important Oncology Related News

The Financial Impact of the Sequester Cut to Medicare Part B Drug Reimbursement in Community Oncology

Medical expenditures for cancer care are estimated to top $158 billion (in 2010 dollars) in 2020, representing nearly a 30% increase compared with 2010.  Adequate access to cancer care continues to be a challenge due to the closing of community-based cancer practices in the United States. The 2018 Community Oncology Alliance (COA) Practice Impact Report stated the following facts from the last 10 years: 423 individual clinics have closed, 658 practices have been acquired by hospitals, 359 practices have reported significant financial instability, and nearly 50 practices sent Medicare patients to receive chemotherapy elsewhere.  READ MORE

Physician Fee Schedule Proposed Rule: Comments due September 10

On July 12, CMS released proposed changes to the Physician Fee Schedule and Quality Payment Program. CMS seeks comment on various proposals by 5 pm ET on September 10. See the proposed rule for information on how to submit your comments.

House and Senate leaders push HRSA to finalize 340B regulations on drug pricing, penalties

A group of lawmakers from both sides of the aisle is asking the Health Resources and Services Administration (HRSA) to push forward with new rules around 340B drug pricing.  READ MORE

Trump administration moves to give Medicare drug plans more control over their offerings

The Trump administration moved Wednesday to give Medicare drug plans more choices in the products they can offer patients, in a bid to boost their buying power and lower drug prices. 

The Centers for Medicare and Medicaid Services announced that, starting in 2020, Medicare prescription drug plans can take advantage of a tool, called an indication-based formulary, that expands the choices of products they can cover, allowing plans to opt for cheaper drugs in certain cases. The announcement Wednesday is the latest part of the Trump administration’s blueprint aimed at lowering prescription drug costs that have spiraled upward in recent years.  READ MORE

COA Position on Step Therapy in Medicare Advantage Plans

On August 7, 2018, the Centers for Medicare & Medicaid Services (CMS) directed Medicare Advantage plans to use step therapy for Part B drugs.

Journal of Clinical Pathways spoke with Fred Schnell, MD, FACP, medical director, Community Oncology Alliance (COA), regarding COA’s official statement on the matter and the anticipated impact this decision will have on Medicare beneficiaries in need of cancer care.  READ MORE

Medicare overpaid millions for radiation therapy planning services, OIG says

Payments for outpatient intensity-modulated radiation therapy (IMRT) planning services did not comply with Medicare billing requirements. Specifically, for all 100 line items in our sample, the hospitals separately billed for complex simulations when they were performed as part of IMRT planning. The overpayments primarily occurred because the hospitals appeared to be unfamiliar with or misinterpreted the Centers for Medicare & Medicaid Services (CMS) guidance. In addition, the claim processing edits did not prevent the overpayments because the edits applied only to services billed on the same date of service as the billing of the procedure code for the bundled payment, and the services in our sample were billed on a different date of service.  READ MORE