Imagine being denied treatment for cancer because Washington bureaucrats decided that a cutting-edge new therapy that could cure you just wasn’t “cost effective.”
That’s already happening in Britain under its government-run health care system, the National Health Service (NHS). And Medicare officials are poised to bring similar policies here.
The NHS’s “Cancer Drugs Fund” restricts physicians’ ability to prescribe half of all oncology medicines. If a medicine doesn’t extend the average cancer patient’s lifespan by a set length of time, which varies according to the medicine’s price, doctors can’t prescribe it for general use—even if it would be the most effective treatment option.
In February, the NHS announced it would review existing general-use drugs to tighten prescribing restrictions. After the review, the number of off-limits drugs will rise. Patient groups predict the move will deny treatment to 22,000 cancer sufferers and “set cancer treatment back by a generation.”
A new proposal from the Center for Medicare & Medicaid Innovation (CMMI) could similarly tie American doctors’ hands. CMMI plans to slash physician reimbursements for medications administered in a doctor’s office under Medicare Part B. Doctors buy these medications up-front and receive reimbursement from Medicare.
The proposed scheme will prevent many doctors from breaking even on the most advanced, most expensive treatments. Essentially, CMMI will cut Medicare spending by forcing doctors to resort to cheaper drugs and second-tier treatments—or run the risk of having to close their practices.
Currently, Medicare reimburses physicians for chemotherapy and certain other medications at the drug’s average sales price (ASP) plus 6 percent. That add-on accounts for the fact that some doctors pay more than the average price. It also covers expenses associated with handling, storing, and administering the drugs.
Often, that 6 percent makes the difference between a viable medical practice and one drowning in red ink.
