Aimed Alliance Says Medicare Part B Demo Discriminates Against Patients with Cancer in Violation of Affordable Care Act

Washington, DC (May 4, 2016) –The Alliance for the Adoption of Innovations in Medicine ("Aimed Alliance"), a not-for-profit organization seeking to improve healthcare in the U.S., called on the Centers for Medicare & Medicaid Services (CMS) today to scrap a proposed program that would test a new way of paying for Medicare Part B prescription medications.

If implemented, the controversial proposed rule for Medicare Program; Part B Drug Payment Model ("Part B Demo") would result in significantly lower reimbursement rates for certain medications, including many that treat cancer, to Medicare providers located in different geographical locations throughout the country.

In its comments to CMS, Aimed Alliance argued that the Part B Demo would harm cancer patients, in particular, in violation of the Affordable Care Act ("ACA"). The ACA and its implementing regulations expressly prohibit all health plans, including those that administer Medicare Part B, from discriminating against any individual on the basis of disability, including cancer. They also prohibit limitations on health coverage or imposition of additional cost sharing on the basis of an enrollee's disability.

Yet, Part B Demo does exactly that. Aimed Alliance argues that the Part B Demo would likely disrupt access to care and increase cost sharing for cancer patients. The Part B Demo is likely to result in fewer private oncology practices, meaning that patients will be forced to obtain treatment from more expensive hospital outpatient departments ("HOPDs"), leading to increased out-of-pocket expenses for patients with cancer. Moreover, with practice closures and consolidations, travel will be necessary to obtain care from any practitioner. Patients with cancer who cannot afford HOPDs may be forced to travel long distances to geographic locations for which the proposed payment scheme is not being imposed, which may become unduly onerous. Patients who are unable to afford care at an HOPD and are unable to travel may choose to forego proper adherence to their treatment plans, leading to higher treatment costs and lower survival rates.

Additionally, the Part B Demo is designed to incentivize oncologists to prescribe less costly cancer medications because such medications will be more profitable under the proposed program.

"The Part B Demo will encourage providers to prescribe cheaper, less effective medications despite the fact that, for some forms of cancer, there are no effective alternatives," said Stacey L. Worthy, Director of Public Policy. "This risky experiment will be done at the expense of elderly cancer patients who deserve quality care."

Therefore, given that the Medicare Part B Demo will likely result in discrimination against cancer patients, in violation of the ACA, by decreasing quality of oncology care, increasing cost sharing for cancer patients, and limiting health coverage by forcing patients to travel long distances or forego adherence to treatment plans, Aimed Alliance urged CMS not to proceed with the implementation of the Medicare Part B Demo.

Aimed Alliance is a tax-exempt, not-for-profit organization that seeks to improve health care in the United States by supporting the development of and access to novel, evidence-based treatments and technologies. For more information, visit www.aimedalliance.org and follow @AdoptInnovation on Twitter.