Depending on what the
Senate does in September, there is a slight chance Congress could act on the Medicare Market
Acquisition Drug Price Act (H.R. 5167). Introduced by Rep. Pete Stark (D-Calif)
in July, the bill would change the way Medicare reimburses oncologists for the
oncology drugs they purchase to administer to patients in the office. Even the
American Society of Clinical Oncology (ASCO) agrees change in the reimbursement
format is necessary. Nevertheless, Paul A. Bunn, Jr, MD, president of ASCO,
says, "Under this bill, reductions in Medicare reimbursement would make it
very difficult for many doctors to continue providing high-quality treatment to
people with cancer."
The Stark bill would pay physicians only 105% of the average
price charged by drug manufacturers. ASCO calls this a "defective"
approach for several reasons. For example, although doctors almost always buy
their drugs from wholesalers, the Medicare payment of a 5% increase over the
manufacturer’s average price could, by itself, fail to cover the wholesaler’s
markup to the physician.
Rep. Stark will have a hard time convincing Congress to pass his bill this
year. The House passed a Medicare reform bill in June, but nothing on payment
for chemotherapy drugs was included. In response, Stark then introduced his
freestanding bill. For the Stark bill to have any realistic chance of action
this year, it will have to be introduced by someone in the Senate and attached
to a Medicare reform bill. The Senate was unable to pass a Medicare reform bill
in July but may try again in September.