The Digestive Health Physicians Association (DHPA) has expressed its support for the “Protecting Patient Access to Cancer and Complex Therapies Act” (S. 2764, H.R. 5391). This act was introduced by U.S. Senator John Barrasso (R-WY), U.S. Representative Mike Burgess (R-TX), and U.S. Representative Greg Murphy (R-NC).
- Background: A provision in the Inflation Reduction Act of 2022 reduced reimbursement for certain Part B drugs from Average Sales Price plus six percent to the Maximum Fair Price (MFP) negotiated by the Centers for Medicare & Medicaid Services (CMS). This led to an estimated cut of 50% or more for drugs that are subject to negotiation.
- Impact: The Inflation Reduction Act unintentionally resulted in significant cuts to physician reimbursements, making it challenging to provide essential medications to patients with chronic illnesses. This could threaten the viability of medical practices, especially smaller groups or those in rural or underserved areas. Patients might be compelled to obtain their medications in costlier hospital settings.
- Solution: The Protecting Patient Access to Cancer and Complex Therapies Act aims to be budget-neutral. It intends to maintain current reimbursements to providers while saving Medicare the same amount of money. This is achieved by replacing the ASP payment cut for Part B drugs with a manufacturer rebate. Patients’ coinsurance would be based on the lower, rebated price, and the manufacturer rebate would account for the coinsurance reduction.
- Statement by DHPA: Dr. Scott Ketover, president and board chair of DHPA, emphasized the importance of the act in ensuring that medical practices can continue to provide complex therapies. He expressed hope that Congress would advance the bill promptly.