ACCC on Capitol Hill

by Amanda Patton, ACCC Communications

ACCC’s 41^st Annual Meeting, CANCERSCAPE, kicked off on March 16 with Capitol Hill Day. ACCC members from across the country fanned out across the Capitol for more than 70 scheduled meetings with legislators and key staff members from both the House and Senate.

With the current Sustainable Growth Rate (SGR) patch set to expire March 31, the timing was ripe for these advocates to speak up for a permanent fix to the SGR.

First time ACCC Hill Day participant Linda Gascoyne, patient advocate for medical oncology, East Maine Medical Center in Brewer, Maine, spent the day with the Maine delegation that met with Senator Susan Collins on Monday, afternoon. “I found her [Senator Collins] to be very empathetic as she listened and learned about what we were asking [from Congress],” Ms. Gascoyne said. In addition to the SGR, the Maine delegation talked with Senator Collins about the need for federal oral parity legislation and elimination of the prompt pay discount from the ASP calculation.

Donna Sulsenti, practice manager, South Shore Hematology Oncology and president of HOMNY was part of the New York delegation that had visits with four congressional offices. “It was extremely interesting speaking about issues with our legislators and getting something accomplished,” she said. She also finds it “satisfying to know that ACCC is working for us.”

Another first time ACCC Hill Day participant Monica Cfarku, nurse manager, Oregon Health & Science University, Knight Cancer Institute, said she “learned a lot” from her meetings with hill staff. In turn, she found staff engaged on the issues and interested in learning from her. “I felt like I offered them a different perspective as someone on the frontline of care delivery.” In fact, staff from a congressional office invited her to return later in the week to share more of her perspective.

Stay tuned for more from ACCC’s Annual Meeting, Cancerscape underway in Arlington, Va. Follow us on Twitter at #cancerscape15.

Ringing in the New Year

by Leah Ralph, Manager, Provider Economics and Public Policy, ACCC

The last few months have brought big changes to Washington, D.C. We will ring in the New Year with both chambers of Congress under GOP control, which means the parties are reorganizing and, importantly, the legislative agenda is shifting. While it’s still anyone’s guess whether new leadership will mean less political infighting in 2015, issues like trade, energy, and tax reform are early contenders for potential areas of compromise next year.

The ACA (Affordable Care Act) will also make the top of the political agenda: starting in January, you can count on Republicans to look for every opportunity to take the legs out from under President Obama’s signature achievement. Although full repeal is unlikely, as it would face an all-but-guaranteed presidential veto, expect the new majority to focus their efforts on introducing a series of stand-alone bills targeting the most unpopular provisions of the law.

Predicting the fate of non-ACA healthcare legislation is a tougher call. On the one hand, healthcare fatigue still looms large among legislators, making issues like a long-term fix to the Sustainable Growth Rate (SGR), oral parity, and sequestration more of an uphill climb. On the other hand, new leadership, a renewed vow to work across the aisle, and public dissatisfaction with the status quo are bringing new energy to Congress.

Will 2015 Bring a Permanent SGR Fix?

In 2014 we saw what was arguably the best opportunity in years to finally fix the fundamentally flawed SGR formula. Congress came to agreement on a bipartisan bill that had a relatively low price tag, but in the end could not reach consensus on how to pay for the fix. As a result, the bill never came to a vote and will need to be reintroduced in the new Congress. Still the fact that Congress achieved consensus on policy is a promising sign for 2015. We have now weathered seventeen (17!) “doc fix” patches that, if added together, cost far more than the comprehensive approach lawmakers are considering today. This year’s ACCC Capitol Hill Day is scheduled for March 16, so we will be visiting with our legislators just weeks before the current “doc fix” expires on March 31.

Will We See Federal Oral Parity Legislation?

Passing a national oral parity law continues to be a top priority for ACCC membership. On the state level, oral parity efforts are gaining momentum. To date, 34 states and D.C. have enacted oral parity laws, and several other states are ramping up their grassroots efforts for 2015. Given that an estimated 25 to 35 percent of all oncology therapies in the pipeline will available only in pill form, the need for comprehensive, federal oral parity legislation is increasingly critical to patient access. While state-level legislation remains important, lawmakers need to understand that federal legislation would ensure consistency in oral parity laws across the country and would include plans that fall outside the purview of state regulation.

Will We See Any Relief from the Sequester?

Last year, legislation to exempt cancer drugs from the Medicare sequester gained more than 100 cosponsors. ACCC will be advocating for this legislation to be reintroduced in 2015.

As you can see, 2015 is the year to make your voice heard! Join us for Capitol Hill Day on March 16, and stay for the ACCC 41^st Annual Meeting, CANCERSCAPE, which will follow March 17–18 in Crystal City, Va. Read our agenda and register today!

If you have additional questions, or would like to get involved with ACCC advocacy, please contact me at lralph@accc-cancer.org.

 

 

ACCC Hill Day Primer—Issue #3: Pass Oral Parity Legislation

by Sydney Abbott, JD, Manager, Provider Economics & Public Policy, ACCC

ACCC’s Capitol Hill Day on March 31 is less than one week away.  ACCCBuzz is featuring a primer series on the key issues ACCC members will be talking about on Capitol Hill. In this third of four installments, we’ll look at the need to pass federal oral parity legislation.

By now you know the issue: oral parity legislation is needed to ensure that patients can afford their oral anti-cancer medications. And you have probably already heard that 29 states have passed oral parity laws requiring insurance companies to cover oral chemotherapies at the same rate they already cover IV-infused medications. Considering that more than half of the states have passed oral parity laws, and that number continues to grow, why is oral parity an advocacy issue for ACCC’s federal Hill Day?

Even though state laws are currently being passed, federal legislation is still required for two important reasons:

1.        Language of the laws varies across the states and only federal legislation will ensure the same protections for all patients; and
2.        State laws only impact state-regulated plans.  Federal legislation is needed to cover self-insured plans (ERISA).

Currently, there are bills in both chambers of Congress, just waiting for ACCC advocates to push them forward. HR 1801 in the House has 71 cosponsors, while the newer S 1879 in the Senate only has one cosponsor.  ACCC members, please speak up for this important legislation.

Those of you coming to Washington, D.C., on March 31^st for ACCC’s Hill Day will have a chance to explain why this legislation matters in person.

ACCC members who cannot make the trip to D.C. next week can still express support for federal oral parity legislation and ask Congress to pass HR 1801 and S 1879. Visit ACCC’s Legislation Action Center to find out how.

Will you be a cancer care advocate? Learn more about the issues, sign up for Hill Day, and make your voice heard.

Protecting Patient Access: Taking It to the Hill

By Sydney Abbott, JD, Manager, Provider Economics and Public Policy, ACCC

We’re on the countdown to ACCC’s Capitol Hill Day on March 31. ACCC members who join us will be visiting with congressional staff to speak out on major concerns affecting oncology care. Those on the front lines of cancer care can deliver a powerful, clear message on issues affecting cancer patients and providers. Patient access to care—in particular to anti-cancer medications—is a cross-cutting concern.

Where Things Stand in Congress—Two Bills

Many health insurance plans cover IV chemotherapy, injected anti-cancer medications, and oral anti-cancer drugs differently, causing patients to pay far more out-of-pocket for oral drugs than for IV chemotherapy or injected medications. With the ever rising cost of healthcare, insurers employ various methods to keep costs down, including increasingly shifting the cost of prescription drugs to patients. To help patients afford the life-saving medications they need, Congress has introduced two complementary—if not somewhat confusing—pieces  of legislation: HR 1801 and companion bill S 1879 to lower the cost of prescription oral chemotherapy drugs, and HR 460, to limit cost-sharing requirements for prescription drugs on specialty tiers. Both bills aim to protect cancer patients in different ways.

Here’s a quick side-by-side comparison of the legislation. For ACCC members joining us for Capitol Hill Day, this snapshot can help you prepare for conversations with congressional staff.

Oral Parity (HR  1801/S 1879)

• Legislation would require insurers to provide coverage for orally administered anti-cancer medication under terms no less favorable than for medication administered intravenously. Insurers may not create parity by raising rates for IV infusions.
• Focus is on cost-sharing across prescription drug coverage and office visit coverage for anti-cancer medications only.
• Requirements: A physician must deem the treatment to be medically necessary for treating cancer, and the treatment must be clinically appropriate in terms of type, frequency, and duration.
• Types of insurance affected: Group  and individual private plans and self-insured group plans regulated by ERISA that cover oral and IV-infused anti-cancer medications.

Specialty Tier (HR  460)

• Legislation would limit cost-sharing requirements applicable to prescription drugs in a specialty tier to the dollar amount of such requirements applicable to prescription drugs in a non-preferred tier.
• Focus is on cost-sharing in prescription drug coverage plans and formularies for any specialty-tier drug covered by the plan.
• Requirements: A health plan that provides coverage for prescription drugs using a cost-sharing structure shall not impose cost-sharing requirements applicable to prescription drugs in a specialty drug tier that exceed the dollar amount of cost sharing for drugs in a non-preferred brand tier.
• Types of insurance affected: Group and individual private plans that cover prescription drugs and use a formulary or other tiered cost-sharing structure. Bill language is unclear as to whether ERISA plans are affected.

Both bills help protect patient access to affordable prescription drugs. However, because oral parity legislation already has 67 co-sponsors in the House and a companion bill in the Senate, this will most likely move through Congress first. Therefore, ACCC will be advocating for oral parity (HR 1801/S 1879) in both chambers on Hill Day. In addition, we will be talking to our representatives about SGR reform, elimination of cancer drugs from the 2% Medicare sequester, and elimination of the prompt pay discount. Learn more about Hill Day 2014 and register today.

Predictions for Cancer Care in 2014

By Matt Farber, MA, Director, Provider Economics and Public Policy, ACCC

To celebrate the New Year in 2012, I wrote a forward-looking blog with month by month predictions of what would happen in Congress and with Medicare during the coming year, and how those changes would affect community cancer care. For 2013, I decided to put the crystal ball aside (although some of my predictions for 2012 were pretty spot on—click here to see how I did), and shared some New Year’s Resolutions focused on getting involved with grassroots activities to spotlight key issues facing oncology in 2013. This year, I can’t resist gazing into the crystal ball again and coming up with some predictions, although as always, I make no guarantees….

SGR Reform: Throughout 2013 the cost estimates for a permanent SGR fix continued to decrease, with the cost now standing at roughly $120-150 billion. Three congressional committees have introduced SGR-fix legislation, and two committees have passed their proposed legislation  with overwhelming support. Still, cost remains the sticking point, and the question of how Congress will pay for a long-term fix remains as yet unanswered. While I do not have any suggestions for that, I do believe Congress will act and pass a long-term SGR fix in 2014. Here’s why:

1. Universal support—Everyone in Congress hates the SGR, and would like this flawed formula to go away.
2. Similar bills—The  House and Senate versions of the SGR-fix legislation are very similar,  therefore there is less chance of disagreement between the chambers.
3. Low cost—$120 billion is still a lot of money, but given that the previous cost estimates were north of $300 billion, the current price tag of $120-$150 billion is a relative bargain.
4. Senator Baucus’s retirement—Senator Baucus (D-MT) will be leaving the Senate in 2014. Fixing the SGR has been a long-time goal for the Senator, so I think we will see a renewed push to get this done.

Sequestration: With the budget deal framework agreed to in December 2013, Congress is rolling back many of the scheduled cuts due to sequestration; however, the Medicare cuts are not included in those rollbacks. Therefore, the 2% reduction to Medicare payments, including drugs, will remain in place. In fact, Congress has even extended the sequester for two more years, so the Medicare cuts are now scheduled to run until 2023. In 2014, ACCC and other organizations will ramp up their efforts to have drugs removed from the sequester cuts by supporting HR 1416 and advocating for this bill to be attached to a larger legislative vehicle, such as the bill to extend the debt ceiling, which is slated for debate in February and March. In order for ACCC to succeed, we need our members to call their elected officials and let them know what the 2% reductions have meant to them and their patients. Congress needs to hear how these cuts are impacting all patients.

Oral Parity: The effort to pass oral parity legislation in every state continues in 2014, with more states taking up the issue. Many states, including Missouri and Michigan, will be carrying over their 2013 debate on this issue, and ACCC and its partners will be advocating for passage of this important legislation. The effort to pass oral parity on the national level took a giant step in the right direction with the introduction of a Senate companion bill (S. 1879) in December 2013. ACCC will work with its partners in the PEAC and SPEAC coalitions to further support these efforts.

Marketplaces: Open enrollment for the insurance marketplaces kicked off in late 2013, and in 2014 coverage under these plans will start. After a very bumpy rollout, patients who signed up for insurance will now have coverage through these plans. The concerns that ACCC has expressed regarding adequate coverage for cancer patients remain in 2014. Many of the plans offered through exchanges may require high out-of-pocket costs, or may leave certain physicians, treatments, or hospitals out of network. ACCC will continue to work with partners on projects such as the Cancer Insurance Checklist to help educate patients and providers on the best plans for cancer patients.

My final prediction is that 2014 will be an exciting year for the oncology community. ACCC will continue to provide resources to its members and to be their voice with lawmakers. This year, as every year, we need your help. Sign up to participate in our Capitol Hill Day on March 31, 2014, being held as part of the ACCC 40^th Annual National Meeting. Attend our spring regional meetings in Minneapolis, Salt Lake City, and Columbus to keep up to date on the latest trends in reimbursement and policy. And as always, if you have any questions, please contact me at mfarber@accc-cancer.org.

Senate Introduces Oral Parity Bill

By Sydney Abbott, JD, Manager, Provider Economics and Public Policy, ACCC

On Thursday, December 19, 2013, Senators Al Franken (D-MN) and Mark Kirk (R-IL) introduced The Cancer Treatment Parity Act of 2013, a Senate companion bill to HR 1810, the House oral parity legislation.  This is great news because all bills must pass both the House and Senate before going to the President for signature. Now, with a version of oral parity legislation in each chamber, momentum on this issue is accelerating.

This is really just a case of technology outpacing policy. Private insurance companies create inequity by charging higher out-of-pocket rates for oral anti-cancer drugs picked up at the pharmacy than for drugs that are infused by a cancer care provider in the physician office setting. When patients receive an IV infusion, they are responsible for a co-pay, generally around $30.  However, when a physician prescribes an oral drug to be filled by the pharmacy, the patient is responsible for some percentage of the total drug cost—in the  case of oral chemotherapies, this can be thousands of dollars per month out of pocket. The proposed oral parity legislation would prohibit insurance companies from charging patients more than the IV-infused rate, no matter the form of administration.

While oral chemotherapies make up a small portion of the oncology drug market currently, that rate is increasing.  Some estimate that oral anti-cancer medications make up 30% or more of the oncology development pipeline.  This is why it is important to pass federal oral chemotherapy legislation now.  The Association of Community Cancer Centers will continue to be on the front line of this issue, and we will keep our members updated.

Oral Chemotherapy Parity: Slowly but Surely…

By Sydney Abbott, JD, Manager, Policy and Provider Economics, ACCC

Congratulations ACCC members in Rhode Island! On Wednesday, July 17, your state became the most recent to sign oral parity legislation into law. This brings the total number of states with oral parity legislation to 26. In 2013, six states have passed oral parity legislation (Florida, Oklahoma, Massachusetts, Nevada, Utah, and now Rhode Island)—clearly oral chemotherapy parity legislation is gaining momentum among the states. See Oral Anticancer Treatment Access Map here.

By now you know that oral parity helps patients access their life-saving drugs by prohibiting private insurance plans from charging higher out-of-pocket costs for oral medications than for IV-infused medications. Cancer patients receiving IV-infusions through the physician office setting are covered under the medical benefit of their insurance plan, generally requiring about a $30 co-pay. However, patients on an oral chemotherapy regimen are covered under their pharmacy benefit, which often requires a cost-sharing component that is some percentage of the total cost of the drug. In the case of oral anti-cancer medications, that can be thousands of dollars out of pocket every month.

It has taken six years to get half of the states to pass these laws and Congress has yet to pass a federal measure, even though bills have been introduced in the past few years. So, why would anyone oppose such patient-focused legislation? There are a few common misconceptions about oral parity legislation that makes some legislators skittish:

1. Given all of the controversy over the “personal mandate” in the Affordable Care Act (ACA), anything perceived as a mandate is given a bad name. Parity legislation is often viewed as mandating insurance plan coverage of oral therapies. However, this is not correct. Parity legislation, whether state-level or federal, only applies to health plans that already cover chemotherapy; there is no mandate to offer coverage for benefits not already provided.
2. Oral chemotherapy drugs are much more expensive than their IV counterparts, so some believe oral parity legislation should not be supported in order to keep the total cost of healthcare down. This is not true when you take the whole picture into account. IV-infusion therapies involve additional costs such as facilities charges, nurse and/or physician time, and materials used to administer the therapy. It’s also important to consider the cost of time and loss of productivity for cancer patients who receive infusions and their caregivers. In addition, overall healthcare costs are higher if there are complications from administering an IV therapy, such as having to treat an infection at the site of infusion.
3. Finally, some believe passing parity legislation would significantly raise insurance premiums for everyone. Studies conducted in states that have passed parity legislation, for example, Indiana, Texas and Vermont, show that any increases in insurance premiums are negligible.

ACCC continues to fight for oral parity legislation on both the state and federal level. While ACCC is pleased that six more states have passed parity legislation this year, we must be vigilant at the federal level, as well. State legislation only impacts individual health plans and small group plans that are not regulated by ERISA. Only federal legislation will cover patients participating in ERISA-regulated plans.

That’s why ACCC is joining forces with others in the oncology care advocacy community to fight for HR 1801, the federal oral parity bill, at today’s 2013 Patient Equal Access Coalition (PEAC) Hill Day.

ACCC asks its members to support this important bill. Click here to compose a message to your legislator in support of HR 1801.