New Analysis Shows Build Back Better Act Will Lead to 42.9% Payment Reductions for Cancer Care Providers

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Oncologists warn that payment cuts in the BBB law will lead to an increase in drug costs and associated costs, not a decrease as the bill provides

If Congress does not correct this Build Back Better Act, Americans with cancer and other serious illnesses will be shocked when their drug prices go up, not down.

– Ted Okon, COA

BROOKLYN, NY, UNITED STATES, November 19, 2021 /EINPresswire.com/ – New analysis shows the wording of the Build Back Better (BBB) ​​law will result in a 42.9% reduction in Medicare payments to independent community oncology practices. Oncologists warn that these latest payment cuts will do the same thing they always did – shut down practices, push more cancer care into more expensive hospitals and, ironically, increase patient costs.

The independent review was conducted by Avalere Health for the Community Oncology Alliance (COA), a national non-profit organization representing cancer care providers and the patients they serve. He examined the impact of how the BBB drug price negotiations between drug companies and the government would be implemented for key Medicare Part B drugs that could be selected for negotiation, many of which are cancer treatments.

Avalere’s analysis shows that community medical oncology will see a 42.9% decrease in Medicare payments due to the way the BBB is operationalizing drug price negotiations. Rather than forcing drugmakers to reimburse the government for lower negotiated drug prices directly, the BBB Act places oncologists and other physicians treating serious illnesses at the risk of receiving lower payments. Practices rely on these payments to cover associated overhead costs, none of which will be reduced – and in fact, they are increasing due to current inflationary pressures and shortages.

Read Avalere’s full analysis of the impact of the BBB law on suppliers.

Research has clearly documented the consolidation of cancer care in hospitals, which dramatically increases drugs for cancer patients and charges significantly more for care. A recent COA study Using self-reported drug price data from hospitals, showed that hospitals charge patients and insurers on average 3.8 times the acquisition costs for already expensive cancer treatments. Another recent study researchers at the University of California, Berkeley found that prices for outpatient services in hospitals were double those paid in doctors’ offices for cancer drugs, and that out-of-pocket spending by patients is significantly higher for care anticancer in hospital.

“When will Congress learn that the pressure on providers by reducing Medicare reimbursement has only led to consolidation and increased costs for patients. It’s not hype – it’s based on historical facts, ”says Ted Okon, COA executive director. “If Congress does not correct this Build Back Better Act, Americans with cancer and other serious illnesses will be shocked when their drug prices go up, not down. “

COA calls on Congress to correct the language of the BBB Act so that drugmakers directly reimburse government excess costs above the Negotiated Maximum Fair Price, or MFP. This creates a direct transaction between government and drug makers and does not pose unnecessary financial risk to independent physicians, such as community oncology practices.

History has shown that repeated cuts to Medicare have resulted in the closure or merging of community oncology practices with hospital systems. The 2020 COA Practices Impact Report found that 1,748 community oncology clinics and / or practices closed, were acquired by hospitals, underwent business mergers, or reported suffering financial difficulties. If community oncology practices shut down due to the dramatic reductions in payments in the BBB Act, the result will ironically be higher costs to patients and more spending on Medicare, not less.

To read Avalere’s full analysis of the impact of the BBB law on providers, visit https://avalere.com/insights/part-b-drug-negotiation-under-bbba-would-reduce-payments-to-providers.

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About the Oncology Community Alliance:
The Community Oncology Alliance (COA) is a non-profit organization dedicated to advocating for community-based oncology practices and, more importantly, the patients they serve. COA is the only organization dedicated solely to community oncology where the majority of Americans with cancer are treated. COA’s mission is to ensure that cancer patients receive quality, affordable and accessible cancer care in their own communities. In the United States, more than 1.5 million people are diagnosed with cancer each year, and deaths from the disease have steadily declined due to earlier detection, diagnosis and treatment. Learn more about ACO at communityoncology.org.

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