Prior authorization is harming individuals with cancer according to new survey results from the Association for Clinical Oncology (ASCO). The survey found that prior authorization delays necessary care, worsens cancer care outcomes, and diverts clinicians from caring for their patients.
ASCO in Action provides the latest news and analysis related to critical policy issues affecting the cancer community, updates on the Association for Clinical Oncology’s ongoing advocacy efforts, and opportunities for members and others in the cancer care community to take action.
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The American Society of Clinical Oncology (ASCO) recently released an updated position statement on drug repository programs. The update shifts ASCO’s position to allow donation of oral cancer drug treatments in an open distribution system - which are drugs that have left the supply chain and have been dispensed to patients.
On November 14, 2022, the Food and Drug Administration granted accelerated approval to mirvetuximab soravtansine-gynx (Elahere, ImmunoGen, Inc.) for adult patients with folate receptor alpha (FRα) positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer, who have received one to three prior systemic treatment regimens. Mirvetuximab soravtansine-gynx is a folate receptor alpha directed antibody and microtubule inhibitor conjugate. Patients are selected for therapy based on an FDA-approved test.
The Centers for Medicare & Medicaid Services finalized changes to Medicare enrollment policy that will make Medicare Part A and Part B coverage effective sooner after an individual enrolls in the program, eliminating gaps or delays in coverage. The Association for Clinical Oncology advocated for these changes in comments on the “Implementing Certain Provisions of the Consolidated Appropriations Act, 2021” proposed rule.
On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released its final rule for the calendar year (CY) 2023 Medicare Physician Fee Schedule and updates to the Quality Payment Program. CMS also released its final rule for the CY 2023 Hospital Outpatient Prospective Payment System the same day. The Association for Clinical Oncology (ASCO) is still assessing the rules, but based on a preliminary analysis, key provisions for the cancer care community are included here.
On October 13, 2022, Department of Health and Human Services (HHS) Secretary Alex Azar extended the COVID-19 Public Health Emergency (PHE) declaration, on the day it was set to expire, for an additional 90 days. The PHE is now set to expire January 13, 2023.
On October 25, 2022, the Food and Drug Administration granted accelerated approval to teclistamab-cqyv (Tecvayli, Janssen Biotech, Inc.), the first bispecific B-cell maturation antigen (BCMA)-directed CD3 T-cell engager, for adult patients with relapsed or refractory multiple myeloma who have received at least four prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
On October 21, 2022, the Food and Drug Administration approved tremelimumab (Imjudo, AstraZeneca Pharmaceuticals) in combination with durvalumab for adult patients with unresectable hepatocellular carcinoma (uHCC).
The Internal Revenue Service (IRS) recently finalized policy changes that make health care coverage more affordable for approximately one million individuals by fixing the so-called “family glitch.” The new policy updates the interpretation of the “affordability” of health insurance plans and allows eligible families to receive tax credits to buy more affordable insurance through an Affordable Care Act (ACA) exchange if employer coverage is too costly.
Building on its longstanding commitment to health equity, the American Society of Clinical Oncology (ASCO) is launching a multi-year pilot program to increase access to high-quality, equitable cancer care in rural Montana. The ASCO pilot program will enable patients to receive cancer care in their own community through a hub-and-spoke care delivery model, a proven method of extending access to cancer care in rural and remote areas.1 This initiative, which aligns with the Montana Cancer Coalition’s comprehensive cancer control strategy,2 aims to reduce patients' commute to treatment locations, enable rural sites to be primary points of contact, improve care delivery through education and training, and encourage patient engagement throughout the cancer care continuum.
In comments to the Centers for Medicare & Medicaid Services (CMS) on the 2023 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, the Association for Clinical Oncology (ASCO) continues to call for a final rule that supports patient access to high-quality, equitable cancer care and support for oncology providers. Highlights from ASCO’s comments are includeded here.
In a step towards addressing one of multiple pending Medicare physician payment cuts, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) introduced the Supporting Medicare Providers Act (H.R. 8800), which would increase the conversion factor to 4.42%, effectively putting the Medicare physician fee schedule cut on hold for a year. The new legislation also includes language that says lawmakers and the Department of Health and Human Services should work to promote and reward value-based care, as well as safeguard timely access to high-quality care by advancing health equity and reducing disparities. The Association for Clinical Oncology supports this effort to provide short-term stability and urges Congress to pass the bill before the end of the year.
The American Society of Clinical Oncology (ASCO) issued a new position statement on Medicare billing for split or shared (split/shared) evaluation and management (E/M) services. The statement summarizes ASCO’s concerns about changes to split/shared E/M services and makes recommendations to better align Medicare coding for E/M services with the care that beneficiaries with cancer need.
Medicare providers are facing significant reimbursement cuts starting January 1. The 2023 Medicare Physician Fee Schedule proposal jeopardizes the financial stability of many oncology practices by proposing a cut to the Medicare conversion factor of approximately 4.5%. Urge Congress to pass important changes that will provide practices with short-term fiscal stability, while simultaneously laying the foundation for long-term payment reforms.