Bipartisan legislation recently introduced by Rep. Tom Reed (R-N.Y.) would ensure that Medicare recipients suffering from cancer and other illnesses are able to use the most recent, advanced treatments.
Reed’s legislation, the Ensuring Equal Access to Treatments Act, would direct the Centers for Medicare and Medicaid (CMS) to use fair payment classifications for new cancer treatments and clinical services that are negatively affected by the current policy.
CMS incentivizes hospitals to use services that are older, cheaper and sometimes outdated through its new “packaged payment” policy. Under the policy, hospitals are reimbursed for drugs and biologics in a single payment instead of being reimbursed for the procedure and the drug separately.
“We heard from patients, doctors and hospitals in the district as well as from across the country that the most up-to-date technology was being reimbursed at such low levels that providers were resorting to using treatments more than 20 years old and less effective,” Reed said. “If patients aren’t receiving the most effective, breakthrough care, that’s a problem we need to find a solution for. Our bill puts patients first and incentivizes quality care outcomes over short-sighted, unfair CMS policies out of Washington.”
Under Reed’s legislation, CMS would be directed to create two separate payment codes. One code would be used for newly packaged drugs and the other code would be used for the procedure required to administer the newly packaged drugs.
“We are grateful for Rep. Reed and the co-sponsors for their leadership on this issue,” Bladder Cancer Advocacy Network Executive Director Monica Smith said. “With so few advances in the disease, it is vital that patients have access to new technology. This change in the rule would greatly benefit the bladder cancer community.”