[Congressional Record Volume 153, Number 108 (Monday, July 9, 2007)]
[Senate]
[Pages S8797-S8798]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER (for himself and Mr. Casey):
  S. 1750. 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, family and our Nation. In 
the U.S. cancer causes one out of every four deaths. Although the 
number of cancer diagnoses appears to have plateaued, more than 1.4 
million Americans will still find out they have a form of cancer in 
2007, and 560,000 will die, keeping cancer the second-leading cause of 
death in the U.S. 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, according to the American Cancer 
Society, the number of Americans who died of cancer in 2006 dropped for 
a second straight year. 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 2006, 43.2 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 a physician's office setting and 
are located in patients' communities. These clinics are especially 
critical in rural areas where access to larger cancer clinics may not 
be available. They provide patients with early diagnoses, effective 
cancer therapies, and innovative and 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 of 2003, MMA, 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 in Medicare's reimbursement for oncology treatment. The 
provisions sought to bring a balance to the reimbursement for the cost 
of cancer drugs and services. Prior to the implementation of the law, 
the Centers for Medicare & Medicaid Services, CMS, reimbursed the cost 
of cancer treatment drugs at a very high level. This level provided 
sufficient funding to supplement the costs of care and the storage of 
the prescription drugs, which were not being provided adequate 
reimbursement. 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, an independent auditing firm, 
estimates that reductions will reach $14.7 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 2005, CMS provided an estimated $300 million in Medicare funding 
to community cancer clinics via a demonstration project, in part as 
stop-gap funding for Medicare reimbursement cuts. This funding was 
reduced to $150 million in 2006 and has been eliminated in 2007. These 
decreases, in addition to other reductions in services payments, have 
resulted in a $200-300 million reduction in reimbursement in 2007. 
However, this reimbursement reduction may be larger than estimated. CMS 
did not factor in the delay in the adjustment of reimbursement rates 
when a drug manufacturer increases the price for cancer therapies and 
the inability of some beneficiaries to pay their Medicare 20 percent 
coinsurance payment. When accounting for these reductions, the overall 
cut to cancer care will likely exceed $300-400 million.
  The MMA 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 of 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 least $150 
million less than the previous funding level.

  Accordingly, I am introducing legislation to provide assistance to 
community oncologists that are disadvantaged by CMS reforms brought 
forth under the MMA. The bill's $1.7 billion cost, 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, however there is a 6-month lag from when 
prices increase in the marketplace and when CMS applies that 
information to increase reimbursement. For example, a price change in 
the first quarter will not be reflected until reimbursement in the 
third quarter. This forces community cancer clinics to often pay 
increased prices for prescription drugs 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 
every 2 months. This will provide reimbursements to oncologists that 
are fair and reflective of market costs.
  2. Removal of the Prompt Pay Discount: The prompt pay discount is a 
discount from the pharmaceutical manufacturer to the wholesaler, not 
the community cancer clinic, for prompt payment on prescription drugs. 
However, the MMA requires that this prompt pay discount be included in 
the calculation of average sales price, ASP, which forms the basis for 
the Medicare drug reimbursement provided, by the manufacturer. This has 
the impact of lowering ASP, thus artificially lowering drug 
reimbursement to community cancer clinics. My legislation would remove 
the prompt pay discount from ASP, requiring CMS to reimburse 
oncologists at the price they actually pay for drugs without the 
inclusion of discounts.
  3. Increase in Payments for Chemotherapy Administration: The MMA 
increased the payment for the first hour

[[Page S8798]]

of chemotherapy administration by 32 percent on a transitional basis in 
2004. The intent of this was to provide an increase in payment for 
cancer care services that were under-reimbursed but subsidized by 
overpayments for cancer drugs under the previous system. While the MMA 
attempted to balance the payment for both drugs and services, including 
increasing payments to cover the increasing costs of delivering quality 
cancer care, the 32 percent was temporary and expired at the end of 
2004. This legislation re-establishes 2004 levels of reimbursement.
  Further, cancer patients can receive multiple hours of chemotherapy 
and must be constantly monitored by skilled oncology nurses. Payment 
for the cost of providing quality cancer care must ensure patient 
safety during the process of administering often toxic medications, 
which can produce life-threatening side effects. To meet this need, 
this bill also provides an increase in funding for the subsequent hours 
of chemotherapy administration at 70 percent of the first hour payment 
rate.
  4. Payments for Oncological Drug Storage: CMS reimbursement for 
oncology prescription drugs does not provide adequate funding for 
storage and care needs. The prescription drugs for cancer care often 
require refrigeration and specialized handling, as some drugs are 
highly toxic. These special provisions result in an increased cost, 
which is why my legislation provides a 2 percent increase in drug 
reimbursement to account for the storage and care of oncology drugs.
  5. Oncology Treatment Planning: Oncology treatment planning provides 
a personalized treatment program for oncology patients. This 
legislation creates two payment codes for treatment planning: moderate 
and complex. Radiation oncologists are currently reimbursed for 
treatment planning; however, medical oncologists, who provide the 
treatment plan foundation, are not reimbursed for treatment planning.
  As both chairman and ranking member of the Labor, Health and Human 
Services, and Education Appropriations Subcommittee, I have sought to 
increase funding for the National Institutes of Health, 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 billion in 2007, an increase of 157 percent, 
while funding for the NCI increased from $2.3 billion in fiscal year 
1996 to $4.8 billion in 2007, an increase of 109 percent.
  In 1970, President Nixon declared war on cancer. Had that war been 
prosecuted with the same diligence as other wars, my former chief of 
staff, Carey Lackman, a beautiful young lady of 48, would not have died 
of breast cancer. One of my very best friends, a very distinguished 
Federal judge, Chief Judge Edward R. Becker, would not have died of 
prostate cancer. All of us know people who have been stricken by 
cancer, who have been incapacitated with Parkinson's or Alzheimer's, 
who have been victims of heart disease, or many other maladies.
  I sustained an episode with Hodgkin's lymphoma cancer 2 years ago. 
That trauma, that illness, I think, could have been prevented had that 
war on cancer declared by the President of the United States in 1970 
been prosecuted with sufficient intensity.
  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 Senator Casey and me to move this legislation forward promptly.
                                 ______