Quick end of year DC updates from the Community Oncology Alliance

In a normal year, December is a slow month on Capitol Hill. This year, it’s been a blur, with activity around the Build Back Better (BBB) Act, the Medicare sequester, PBM legislation, and questions about the OCM.?

Before you head off for the holidays, here’s what we know about the major items Congress and CMS are discussing:

BBB Act – and Included Cancer Cuts – Will Not Pass Before 2022

The BBB Act will not pass before the end of the year. President Biden and Majority Leader Schumer are still trying to get Senator Manchin on board with the bill but haven’t had any luck doing so. Given the gap between Manchin and Democratic leadership, the president has admitted that the bill will be punted to 2022.?

The latest version of the BBB still features a 42.3% cut to Medicare payments for cancer care and uses community oncology providers as bargaining chips for drug price negotiations. COA continues to meet with lawmakers about the devastating effects these cuts would have on cancer care and is working on additional analyses of the bill’s impact. We’ll continue the fight in the new year.?(Read more about the BBB Act and cancer care here. )

Medicare Sequester Paused Until March 2022, and Other Cuts Averted

Earlier this week, Congress passed a bill, and the president signed it into law, to raise the debt ceiling limit. The bill contained several provisions stopping or reducing impending Medicare cuts impacting practices.?Specifically:

• 2% sequester Medicare cut moratorium extended?through March 2022. After that, a 1% sequester cut goes into effect through June 2022, and the full 2% cut goes into effect in July 2022. Although the delay isn’t permanent, it does give us more time to fight the cut and make it permanent. That being said,?
• 4% PAYGO Medicare cut?waived?until 2023.
• 3.75% Medicare fee cut?largely mitigated.?This cut was originally in the 2022 Physician Fee Schedule. 3% of the cut has been stopped, but a .75% cut will go into effect starting January 2022.

Overall, we were very successful in delaying or stopping massive looming Medicare payment cuts to providers. You’ll receive updates from CAN and COPA leaders on the January calls about the cuts that are still happening and plans for mitigation.?

Still No Word from CMS on the Future of the Oncology Care Model, but Radiation Oncology Model Delayed

It is still radio silence from CMS on the future of the OCM or our request to extend the OCM. Despite more recent data indicating success from practices participating in the model, we believe CMS is proceeding as planned to halt the intake of new patients in January 2022 and close the model in June 2022. We are now petitioning Congress to intervene as it is apparent that CMS does not have a plan to help cancer care providers transition to a new model or back to MIPS.

In the debt ceiling bill mentioned previously, Congress also delayed the Radiation Oncology Model until January 2023. It remains to be seen if CMS or CMMI will pull the model entirely due to mounting frustrations with COVID delays, but that is something that has been discussed. As with the other items, we are talking to Congress and leaders at CMS about these scenarios.?

CMS Signals Intent to Address PBM DIR Fees

Legislators and regulators are starting to take notice of PBM misbehavior. In mid-November, COA executive director Ted Okon participated in a forum led by the Republicans of the House Oversight Committee asking for more information on the role of PBMs in rising drug prices. Last week, the committee issued a?scathing report ?on PBM tactics.

It appears that the administration is finally starting to take notice: This week, legislators were given notice by CMS that action will be taken to curb PBM abuses.?Senator Tester of Montana, who introduced the?Pharmacy DIR Reform to Reduce Senior Drug Costs Act , and Representative Buddy Carter of Georgia, who participated in the PBM forum, both received?letters from CMS ?indicating that the agency will be reviewing the effects of “troubling” DIR fees and taking action to eliminate or reduce them.?

It remains to be seen how serious CMS is about addressing PBM DIR Fees and how meaningful the actions they take will be. COA members will recall that the previous administration attempted to tackle PBM rebates in 2020 but made little meaningful progress. We will keep you posted on any developments or progress made.??

What’s Next?

COA has a full plate in 2022 and is hopeful for progress on our top priorities. Given CMS’ readiness to work on PBM issues, we’ll hit DIR fees and prior authorizations hard in our conversations with them. That doesn’t mean the BBB Act, OCM, or RO Model are taking a backseat – we’ll be first in line any time those conversations are had, and we will continue our efforts to reform the out-of-control 340B program so that it benefits patients directly.

We need YOUR help, though. If you have stories or data that helps, tell the story of community oncology, we want to hear from you and we want you engaged! Your words matter to your representatives. In the meantime, make sure you’re signed up for COA emails and that you’ve joined or renewed your COA membership for 2022, so you’re in the know. If you need help with either of these, please let us know.?

Happy holidays and New Year to you, your staff, patients, and families!