On April 22, CSRO held several meetings on Capitol Hill to advocate for the Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299). This bipartisan legislation is critical to ensuring continued access to Part B medications selected under the Medicare Drug Price Negotiation Program (MDPNP). CSRO and its board member, Harry Gewanter, MD, were joined by the Patient Access to Community Treatment (PACT) Coalition, of which it is a member.
The Protecting Patient Access to Cancer and Complex Therapies Act would address an unintended consequence of the MDNP that, if left unaddressed, would have a harmful impact on community physician practices. Under the Medicare Price Negotiation Program (MDPNP), Medicare can set a Maximum Fair Price (MFP) for select Part B drugs, which are typically administered in physician offices or hospital settings. Currently, physicians are reimbursed at the Average Sales Price (ASP) +6%, but the new rule would change this to the Maximum Fair Price (MFP) +6, blending MFP into ASP calculations. According to a recent Avalere study, this change could reduce Part B add-on payments by 42-61% in Medicare and 12-18% in the commercial market, threatening the financial viability of private physician practices that rely on the "buy-and-bill" model. This could force providers such as rheumatologists to transfer patients to hospitals, thereby increasing costs and potentially limiting patients’ access to medications.
The Protecting Patient Access to Cancer and Complex Therapies Act would remove physician Part B drug reimbursement from MDPNP negotiations, maintain reimbursement at ASP + 6%, and require pharmaceutical manufacturers to pay rebates to CMS for the difference between ASP + 6% and MFP + 6%. This aims to protect access to Part B medications for 60 million Medicare beneficiaries while ensuring cost savings for the government and reducing patients' out-of-pocket costs.
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