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Medicare Reimbursement
for Oncology Services
Continued from
page 1
legislation in the final hours of the 2001 Congressional session that would
substantially change the formula for Medicare reimbursement for life-saving
therapies. (For additional information, please see the November/December
issue of NPAF Washington Update).
CURRENT STATUS:
NPAF and our colleagues in the cancer community mobilized quickly and were
successful in reaching an agreement with Congressional leaders to delay action
on the issue until 2002. NPAF believes that reform of the current system is
needed, and the NPAF Policy Board has approved a detailed set of principles
for reform. These principles are:
- Medicare reimbursement for covered prescription drugs must more accurately
reflect the cost at which providers are able to purchase covered prescription
drugs.
- Surveys of medical practices to obtain information regarding acquisition
prices for covered prescription drugs must directly reflect the diverse
geographic and size differences of medical practices in the United States.
- Legislative efforts to reform the current Medicare reimbursement methodology
for covered prescription drugs must result in a reimbursement rate for covered
prescription drugs that reflects an acquisition cost that may be obtained
by at least 90 percent of all participating providers.
- Cost savings achieved through the use of generic substitutions must be
reflected in beneficiary co-payments.
- Medicare reimbursement for practice expenses associated with providing
quality cancer care should more accurately reflect the actual cost to providers,
including the costs of professional caregivers such as oncology nurses,
oncology social workers, oncology case managers and oncology pharmacists.
- Legislative efforts to reform the current Medicare reimbursement for practice
expenses must reflect the costs associated with storage and maintenance
of drug inventory, costs of carrying debt for drug purchases while awaiting
reimbursement, drug spillage/waste and medical supplies needed for the mixing
and administration of covered prescription drugs.
- Physicians must be reimbursed an adequate fee for the day-to-day management
of cancer patients.
NPAF will continue to play a leadership role in advocating for responsible
reform of the Medicare reimbursement system to ensure that access to quality
care is preserved.•
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