Upton-led bill preserves Medicare beneficiaries’ access to cancer care

Legislation introduced by U.S. Rep. Fred Upton (R-MI) would address issues in the Medicare reimbursement formula that can leave medical providers inadequately compensated for providing cancer treatments and care.

The vast majority of new cancer patients seek treatment through community-based cancer centers. Ensuring more appropriate payment amounts for cancer drugs under Medicare Part B would help protect those cancer centers, lawmakers said.

“Here in Michigan we have 19 dedicated cancer centers including the Lakeland HealthCare Marie Yeager Cancer Center in St. Joseph,” Upton said. “Our common sense, bipartisan legislative fix corrects the Medicare reimbursement formula that currently threatens the distribution of cancer care drugs across the country. This will ensure patients continue to receive the highest quality cancer care available. I look forward to working with my colleagues on both sides of the aisle here in the House and in the Senate to move this bill forward.”

The bill, H.R. 1920, would amend the Social Security Act to exclude prompt pay discounts given by drug manufacturers to distributors from the average sale price of drugs and biologics under the Medicare Part B reimbursement formula.

Prompt pay discounts are used to compensate drug distributors for shipping, handling and distribution costs. The inclusion of those discounts in Medicare’s reimbursement formula lowers reimbursement rates to providers, jeopardizing Medicare beneficiaries’ access to cancer care.

U.S. Rep. Gene Green (D-TX), who introduced H.R. 1920 with Upton, said the prompt pay discount has adversely impacted the delivery of treatment to seniors and practicing physicians.

“This needed fix of the Medicare reimbursement formula will help maintain the type of robust provider network we need to ensure quality health care options for Medicare beneficiaries in the years to come,” Green said.

U.S. Reps. John Shimkus (R-IL) and Pat Tiberi (R-OH) are original cosponsors of the bill.