Help Pass Priority Legislation on Medicare Reimbursement, Research Funding, Prior Authorization, FDA Reforms by End of the Year

December 6, 2022

The time after an election but before newly elected officials are sworn in is commonly called a “lame duck” period. The current lame duck extends from November 14, 2022, until January 2, 2023. Starting January 3, the 118th Congress will begin, and any legislation introduced in the 117th Congress, but which was not signed into law, must be reintroduced and gain Congressional supporters all over again.

Throughout the 117th Congress, the Association for Clinical Oncology (ASCO) and its volunteer advocates have made significant progress in advancing key legislation to provide robust federal funding for cancer research, avoid Medicare reimbursement cuts, streamline prior authorization, and reform the U.S. Food and Drug Administration (FDA). However, the coming end of the current Congressional session means that advocates must act quickly to urge Congress to pass priority legislation and avoid having to reintroduce such bills in 2023.

Read on to learn more about these issues and how you can help move key cancer policy legislation across the finish line into law.

Fiscal Year 2023 Budget 

The current Continuing Resolution (CR) funding the government at Fiscal Year (FY) 2022 levels expires on December 16, which means Congress must pass a full FY 2023 budget or another CR by that date. ASCO urges Congress to pass a full FY 2023 budget as soon as possible that provides $49 billion for the National Institutes of Health and $7.76 billion for the National Cancer Institute.

Medicare Reimbursement Cuts  

Without Congressional action before the end of the year, Medicare providers will face up to a 10% reimbursement cut in 2023. The cut is comprised of a 4.47% cut to the Medicare conversion factor in the 2023 Medicare Physician Fee Schedule (PFS) final rule and a 4% PAYGO cut, both of which are set to begin on January 1, 2023. Furthermore, the 2% sequestration cut went back into effect on July 1, 2022, and absent Congressional action, 5% bonus payments incentivizing participation in Advanced Alternative Payment Models (APMs) end in 2022. Among other actions, ASCO recently joined the American Hospital Association and American Medical Association in sending  a letter to Congressional leadership urging them to waive the statutory PAYGO sequester cuts. 

ASCO is also asking Congress to provide at least a 4.5% conversion factor adjustment for 2023, by passing the Supporting Medicare Providers Act of 2022 (H.R. 8800). We joined the broader provider community in endorsing the legislation and calling on leadership to prevent the conversion factor cuts from going into effect.  In addition, we urge Congress to waive the 4% statutory PAYGO requirement, eliminate the 2% Medicare sequestration cuts, and provide a one-year inflationary update based on the Medicare Economic Index.

Prior Authorization 

One of ASCO’s top legislative priorities is addressing the burden of prior authorization. A recent ASCO survey found that nearly all respondents report harms to patients due to prior authorization processes. Passing the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018) by the end of this year is imperative to addressing this burden. While the House of Representatives has passed this important legislation, the bill still needs to pass in the Senate before it can be signed into law.

Support Critical Reforms at FDA 

As Congress negotiates a year-end legislative package, ASCO is advocating that they include several Food and Drug Administration (FDA) policy provisions that would improve the drug development and approval process and FDA’s regulatory oversight. These bipartisan provisions were supported by and passed out of the House of Representatives earlier this year as part of the FDA User Fee package, but unfortunately, they were not included in the final package taken up by the Senate. These remaining provisions include improving diversity in clinical trials, strengthening program integrity for the Accelerated Approval pathway, and expanding the use of real-world evidence.

ASCO also urges the inclusion of the Verifying Accurate Leading-edge IVCT Development (VALID) Act in year-end packages. The bill would reform the regulatory framework for clinical laboratory diagnostics to protect patients and ensure access to innovative and high-quality testing, creating a distinct regulatory framework for in vitro diagnostics and risk-based regulatory standards for tests, while streamlining oversight of existing tests.

Please visit the ACT Network and tell your lawmakers to address these issues prior to the end of the year!

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