[Congressional Record Volume 152, Number 23 (Tuesday, February 28, 2006)]
[Senate]
[Pages S1547-S1548]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER (for himself, Mr. Coleman, and Mr. Isakson):
  S. 2340. A bill to amend title XVIII of the Social Security Act to 
preserve access to community cancer care by Medicare beneficiaries; to 
the Committee on Finance.
  Mr. SPECTER. Mr. President, I have sought recognition today to 
introduce the Community Cancer Care Preservation Act, which will ensure 
Medicare beneficiaries' access to community-based cancer treatment and 
provide Medicare reimbursement assistance for oncologists providing 
vital cancer care services.
  Cancer takes a great toll on our friends, families, and our Nation. 
In the United States, cancer causes one out of every four deaths and 
was responsible for 570,000 deaths last year. In 2005, over 2 million 
new cases of cancer were diagnosed, the most prevalent of which were 
breast, prostate, lung, and colorectal.
  While these statistics are daunting, the rate of cancer deaths in the 
United States has decreased since 1993. This decrease is the result of 
earlier detection and diagnosis, more effective and targeted cancer 
therapies, and greater accessibility to quality care provided by 
oncologists. These vital services have allowed millions of individuals 
to lead healthy and productive lives after successfully battling 
cancer.
  In 2004, 42.7 million individuals were enrolled in Medicare; of those 
beneficiaries over 29 percent have had cancer during their lives, 12.5 
million beneficiaries. With such a large percentage of our seniors 
facing this horrible disease, the need for access to community cancer 
care is critical.
  Community cancer clinics treat 84 percent of Americans with cancer. 
Community cancer centers are free-standing outpatient facilities that 
provide comprehensive cancer care in the physician's office setting 
located in patients' communities. These clinics are especially critical 
in rural areas where access to larger cancer clinics is not available. 
They provide patients with earlier diagnosis, more effective cancer 
therapies, and innovative supportive care that reduces fatigue, nausea/
vomiting, and pain. The accessibility of treatment in the hands of 
skilled community oncologists has decreased the cancer mortality rate.
  On December 8, 2003, the Medicare Prescription Drug Improvement and 
Modernization Act was signed into law by President Bush. This 
legislation contained numerous provisions that were beneficial to 
America's seniors and medical facilities; however, it also provided a 
reduction to Medicare's reimbursement for oncology treatment. The 
provisions sought to bring a balance to the reimbursement for the cost 
of cancer drugs and services. Previous to the implementation of the 
law, CMS reimbursed the cost of cancer treatment drugs at a very high 
level. This level provided sufficient funding to supplement the costs 
of care, storage of the prescription drugs, and the costs of cancer 
care services, which were not being provided adequate funding. The law 
enacted reimbursement reductions for the cost of prescription drugs 
while increasing the funding provided for cancer care services; 
however, that increase did not sufficiently offset oncologists' losses 
from the reduction in cancer drug reimbursement.
  The Congressional Budget Office estimated that Medicare 
reimbursements to oncologists would be reduced by 
$4.2 billion from 2004-2013. PricewaterhouseCoopers estimates that 
reductions will reach $15.7 billion over that time. This increased 
reduction will have a debilitating effect on oncologists' ability to 
provide cancer treatment to Medicare beneficiaries, especially those in 
the community setting.
  For 2006, the Centers for Medicare and Medicaid Services (CMS) 
estimates that the beneficiary reimbursement for services provided by 
community cancer care will be cut by 6.6 percent, a $200 to $300 
million reduction. However, this reimbursement reduction may be larger 
than estimated. CMS did not factor in the delay in drug manufacturer 
price increases for cancer therapies and the bad debt of beneficiaries 
who may not pay their Medicare 20 percent co-insurance payment. When 
accounting for these reductions, the overall cut to cancer care will 
likely exceed $300 million.
  The Medicare Prescription Drug and Modernization Act mandated a 
transitional increase of 32 percent in service fees in 2004, falling to 
3 percent in 2005, and 0 percent in 2006. This was done to provide time 
for CMS to pay for essential unpaid medical services, such as pharmacy 
facilities and treatment planning. In 2005, CMS created a cancer care 
demonstration project as a quality enhancement initiative to examine 
the effects of oncology drugs on patients. This demonstration project 
also provided $300 million in critical funding because CMS had not 
increased the reimbursement for essential unpaid medical services. On 
June 29, 2005, I sent a letter with 38 other Senators to President Bush 
requesting an extension to the demonstration project through 2006. CMS, 
however, announced a new oncology demonstration project for 2006 that 
examines the quality of cancer care in relation to treatment 
guidelines, but at $180-$210 million less than the previous funding 
level.

[[Page S1548]]

  Accordingly, I am introducing legislation to provide community 
oncologists with the tools to withstand the CMS reforms brought forth 
under the Medicare Prescription Drug and Modernization Act. The bill's 
$1.7 billion price tag, over the next 5 years, is a relatively small 
cost in the face of the vast reductions in CMS's reimbursement to 
oncologists. Let me briefly summarize the provisions of this 
legislation.
  1. Sales Price Updates: Currently, CMS updates the prices for cancer 
treatment drugs quarterly. This delay in price updating forces 
community cancer clinics to often pay increased prices for prescription 
drugs for up to six months without increased reimbursement. This 
legislation requires the sales price for oncology drug reimbursement be 
updated as changes occur in the price to provide a more accurate 
reimbursement to oncologists for the cost of drugs. This will provide a 
reimbursement to oncologists that is fair and reflective of market 
costs.
  2. Removal of the Prompt Pay Discount: The prompt pay discount is a 
discount from the wholesaler to the physician for prompt payment on 
prescription drugs. This is a benefit for physicians that operate an 
efficient and organized practice and allows them to gain extra revenue 
as an incentive for conducting business in that manner. The current 
average sales price for prescription drugs from CMS takes into account 
the prompt pay discount provided by wholesalers. The inclusion of these 
funds, which are not guaranteed unless the practice operates in a very 
efficient way, decreases the amount of reimbursement from CMS. My 
legislation would remove the discount from the CMS average sales price 
requiring CMS to reimburse oncologists at the price they pay for drugs 
without the inclusion of discounts.
  3. Quality Care Demonstration Project Extension: The quality care 
demonstration project provided information to CMS that was gathered by 
oncologists about the effects of oncology drugs on patients. This 
project was altered and funds were reduced provided to conduct the 
informational interviews to oncologists. The bill would extend the 2005 
quality cancer care demonstration project through 2006. The project 
collects information from cancer patients on the effects of cancer 
treatment including fatigue, nausea/vomiting, and the treatment of 
these symptoms.
  4. Increase in Payments for Oncological Drug Storage: The CMS 
reimbursement for oncology prescription drugs does not provide adequate 
funding for storage and care needs. The prescription drugs for cancer 
care often require special provisions including refrigeration and 
handling as some drugs that are highly toxic. These special provisions 
result in an increased cost, which is why my legislation provides a two 
percent increase in payments to account for the storage and care of 
oncology drugs.
  5. Reports Regarding Cancer Care: The legislation would also require 
a report from the Secretary of Health and Human Services on a plan to 
increase the number of cancer patients in clinical trails and a 
Congressional Budget Office Report on the effects of the Medicare 
Prescription Drug Improvement and Modernization Act of 2003 on cancer 
care. These reports will assist Congress and the Administration in its 
future decisions impacting cancer care.
  As Chairman of the Labor, Health and Human Services, and Education 
(LHHS) Appropriations Subcommittee, I have sought to increase funding 
for the National Institutes of Health (NIH) and the National Cancer 
Institute (NCI). Since becoming Chairman of the LHHS Subcommittee, the 
funding for NIH has increased from $11.3 billion in fiscal year 1996 to 
$29.4 billion in 2006, an increase of 147 percent, while funding for 
the NCI increased from $2.3 billion in fiscal year 1996 to $4.9 billion 
in 2006, an increase of 113 percent.
  On February 16, 2005, I was diagnosed with stage IVB Hodgkin's 
lymphoma and had my first chemotherapy treatment two days later. I had 
a total of 12 treatments, my last on July 22, 2005, and tests following 
that final treatment concluded that I am cancer free. As a recipient of 
cancer treatment for Hodgkin's lymphoma cancer, I have an acute 
understanding of the problems that confront patients as well as 
physicians that administer their care.
  This legislation provides Medicare reimbursement assistance for 
community oncologists and ensures Medicare beneficiaries' access to 
community-based cancer treatment. I encourage my colleagues to work 
with Senators Coleman, Isakson and me to move this legislation forward 
promptly.
                                 ______