New rules from Washington, D.C., bureaucrats threaten access to life-saving medicines for Medicare patients across Colorado and could result in community health clinics shutting their doors — all in the name of some potential cost savings.
The fight to stop these new, ill-conceived rules will be one of the biggest fights in the new Congress.
The latest scheme put forth by the federal Department of Health and Human Services (HHS) would set prices for Medicare Part B drugs based on the prices in other countries, including countries that have socialized health care.
These countries keep prices artificially low and intentionally prevent patients from having access to the cutting-edge medicines they can get here in the United States.
By setting somewhat arbitrary reimbursement rates for drugs, tied to an international standard, analysts are predicting severe consequences for patients with the most severe diseases, including cancer, and many auto-immune conditions, such as rheumatoid arthritis, multiple sclerosis and lupus.
How would this happen?
The new system, known as the International Pricing Index (IPI) model, upends the current common-sense, free-market system that takes into account the many discounts and rebates already in place. This effective system helps reduce consumer prices while maintaining the broadest access to the drugs patients need.
The international benchmark, in contrast, artificially suppresses prices through government restrictions on access to costlier medicines, often the very medicines that physicians prescribe to treat cancer patients and prolong their lives. The focus of the IPI model is not on patients’ needs but on ledger sheets.
This will be a stark change for Colorado Medicare patients compared to the broad access to medicines that they enjoy today. A recent study showed that in the 14 countries that would be part of the IPI system, patients have access to only 55 percent of new cancer medicines, compared to 95 percent in the United States.
Researchers also found that of the 27 new cancer medicines that were included in the study, only 11 were available to patients in all 14 countries, while all are covered in the United States by Medicare today without restriction.
This is why the proposed HHS rules are a giant step backward for Medicare patients.
Fast forward to a day in the near future, with these rules in place, where physicians may be forced into the difficult conversation with a patient, knowing that he or she needs a specific new medicine.
I spoke with an oncologist who said having to tell that patient that Medicare bureaucrats are denying access to that drug puts the physician in an unethical situation.
It isn’t only access to medicines that these new rules threaten; it’s access to community-based treatment facilities, including independent cancer clinics.
Throughout our state, and particularly in less-populated areas, community clinics provide a smaller, more intimate, more patient-friendly setting for treatment. These facilities are also convenient, allowing a cancer patient to be treated closer to home rather than driving hours one way several times a month or more for chemotherapy/radiation.
Like other health care facilities in rural Colorado, some community clinics operate on either a break-even basis or a small loss, and we are seeing many clinics have to close their doors due to lack of adequate reimbursement for services.
In fact, we can track the drop in Medicare reimbursements by the number of clinics that have shut down. The proposed HHS rules would dramatically worsen this situation.
We also know that these rules will make it more difficult to develop new cutting-edge drugs that hold huge promise for patients. A study by HHS itself showed that IPI results in an average drop of up to 16 percent in the funding available for research and development worldwide.
This is yet another example of how the proposed rule gives priority to bureaucratic bean-counting over the needs of future Medicare patients.
The good news is that there is a grassroots groundswell to point out the many flaws in this proposal and encourage Congress to step into halt these new initiatives. A letter to congressional leadership signed by 338 organizations from around the country was recently delivered to Capitol Hill. Patients and caregivers from Colorado and across the nation are also speaking out.
By threatening the future of cancer care, especially for rural Coloradans, this Medicare experiment would have dire consequences for many Americans for years to come.
The Trump administration must listen to the countless patients, physicians and bipartisan members of Congress who all agree that the International Pricing Index is bad medicine and should be withdrawn.
April Christensen is executive director of the Coalition for Hematology and Oncology Practices (www.choptx.org) based in Fort Collins.
