This is an exciting time in oncology. Remarkable discoveries in cancer research are providing increasingly effective treatments, and the increasing number of cancer survivors are living proof of this real progress.

Treatment advances, however, are only as good as our ability to deliver them to patients.

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Vice President Biden’s Cancer Moonshot initiative seeks to double the pace of progress, a goal that cannot be achieved unless the cancer care infrastructure and delivery system is healthy with full patient access to ever-improving treatments.

We recognize the escalating costs of many new, life-saving anti-cancer drugs. However, the plan by the Center for Medicare & Medicaid Services (CMS) to launch a mandatory experiment to remedy the current fundamentally flawed drug reimbursement system is misguided. The Administration’s Medicare Part B proposal is not the solution. Instead, it would threaten access to high-quality cancer care for millions of Americans living with cancer. The demonstration addresses only one narrow piece of the escalating cost of clinical care, and the CMS proposal misses a real opportunity to advance quality and outcomes for Medicare beneficiaries.

While we agree with the need to address the high cost of drugs, the demonstration would not solve the problem. Instead it simply squeezes physicians – who do not set or control drug prices – by reducing reimbursement for Part B drugs to the extent that many practices will be reimbursed less than what they pay to purchase cancer drugs. This circumstance will lead to either patients not receiving highly effective drugs or patients being redirected to receive care elsewhere, usually to higher-cost treatment facilities. Ironically, such an outcome will increase Medicare costs by approximately 30 percent, challenging the CMS assertion that the demo would be budget neutral. Further, it might even threaten the dwindling supply of community oncology practices.

Moreover, the experimental nature of the proposed demonstration could result in devastating, unintended consequences for patients. The CMS proposal lacks quality protections, monitoring provisions, and other safeguards typically required to protect clinical trial participants—creating substantial risks for Medicare beneficiaries who can't opt out.

The demonstration wrongly assumes that oncologists have the ability to select from several, equally effective treatments of varying costs. A handful of exceptions aside, typically only one suitable anti-cancer treatment is available for a given patient, based on the tumor type and its molecular profile, as well as the health of the patient.   

Cancer doctors have done their best to make the patchwork quilt of Medicare reimbursement policies work by using Part B reimbursements to pay for essential cancer care services that are either inadequately covered or not covered at all, such as treatment planning, patient education, patient and family counseling, coordination of care, mental health services, genetic and financial counseling, and nutrition counseling. Oncologists are not responsible for the high cost of drugs, but putting them at risk for these costs will drastically cut into these other essential services, if not prevent their administration completely.

Payment reform initiatives must address the need for high-quality, high-value care. We support meaningful changes to address healthcare costs,  but these guiding principles must be kept in mind. Incremental attempts to fix the system, such as the proposed Plan B demonstration proposal, will only limit resources and hinder meaningful reform.

This proposal must not move forward. A diverse chorus of voices is calling on Congress to intervene and pass H.R. 5122 or similar legislation to prevent this ill-advised demonstration project from proceeding. ASCO is committed to working with Congress and CMS to bring about comprehensive, value-based payment reform for high-quality care. We can do better than the Part B demo.

Daniel F. Hayes, MD is president of the American Society of Clinical Oncology. Clifford A. Hudis, MD is Chief Executive Officer of the American Society of Clinical Oncology.


The views expressed by authors are their own and not the views of The Hill.