Dr Debra Patt Pushes for PBM Reform and Physician Reimbursement Fixes

Debra Patt, MD, PhD, MBA, MPH, serves as executive vice president of Texas Oncology, medical director for public policy for The US Oncology Network, and now, president of the Community Oncology Alliance (COA). In an interview from January 10, 2025, she emphasized the urgent need for policy reforms to improve patient access to care, highlighting key issues such as pharmacy benefit manager (PBM) transparency, potential changes to 340B reimbursement, and physician reimbursement challenges. Patt stressed that aligning stakeholders across the health care system is critical to ensuring sustainable solutions for community oncology and broader health care access.

This transcript has been lightly edited; captions were auto generated.

Transcript

Can you discuss the theme, “Empower and Advocate,” the idea that empowering colleagues to advocate really extends to everyone?

I think COA does a great job of aggregating many different individuals that touch the community oncology ecosystem—doctors, nurses, administrators, pharmacists, advanced practice providers, patients, patient navigators—and so there's an important role for everyone to be empowered and to advocate. We see a lot of challenges in public policy that pose a risk to community oncology. So I think heightening awareness for various stakeholders is really important, as we each hold an important part of the story, sort of like puzzle pieces that you put together. Each of us holds an important part of the story about how to make a great community oncology practice.

Frequently, here in Texas, as I serve as a vice president of Texas Oncology, we have public policy meetings in our districts, and so either at a cancer center or at a local site, we will have a meal or a presentation with elected officials and have different people there—patients, social workers, practice administrators and leaders, pharmacists, nurses, doctors—and we each hold different pieces of how patients with cancer struggle in their communities, and what policy changes we could consider to try to make it better for patients.

There are some obviously loud, resounding themes there that you've heard from COA before about things that can enhance community oncology. But it's really useful, actually, to hear everyone's perspective because as a doctor, I have one perspective about that. Things like prior authorization and the ability to give patients the first therapy that I want for them instead of fail-first step therapy limitations are great examples of things that I feel day to day. [Or] the issues of network inadequacy, as I try to call different primary care providers and beg for them to see my patients because they're [having] a difficult time finding a primary care provider.

Those are things as the doctor that I feel, but there are different ways in which patients and patient advocates see the challenges in community cancer care. It may be in navigating their copay accumulator; it may be in getting their out-of-pocket costs reduced; it may be in managing the balance between their work and the therapy that they're getting. And again, social workers will look at it differently; administrators will look at it differently.

I think COA does a great job of aligning various stakeholders and educating them on how to advocate effectively and trying to bring us all together so that we all act as a team.

Let’s discuss the policy agenda, because that's a big part of what COA hopes to advance this year. As we have this discussion (January 10, 2025), knowing how close advocates for PBM reform came in the last session, what do you look forward to this spring?

I think that you are going to see a lot more advocacy on public policy from COA this year. It’s always our strong suit, but you're going to see it even stronger and coordinated as we think about our Prescription for the American Health Care System and engage with some new stakeholders, as the new administration comes into office and sets their priorities.

I think what we've learned from the prior Trump administration is that there is an interest in managing “the middleman” or cutting out the middleman in care delivery. To me, that speaks to a prioritization on reining in pharmacy benefit managers—things that facilitate transparency and accountability, I think make a big difference, and I suspect that that will be a priority for the administration this next year.

In a similar vein, as you think about where you have costs in the health care ecosystem, the first Trump administration previously did want to make changes in the 340B reimbursement—there was a decrease in reimbursement to 340B programs. Now, that was not upheld at the Supreme Court level, but the Supreme Court's decision dictated that they required data to really think about reimbursement appropriately. We have that data now, so it would seem reasonable for me for the Trump administration to revisit that data and try to understand how that could influence 340B reimbursement, and particular action as it relates to child sites. I believe 340B represented $126 billion of drug purchasing last year, so it’s a tremendous cost to the health care ecosystem.

Now, one thing about health care that I think is complicated is that you can't change everything perfectly so quickly. Because even if you think the reimbursement for 340B is inappropriate, it's hard to change everything all at once, because there are important parts of the ecosystem that have become dependent upon those finances. I think it's going to take a really careful and thoughtful consideration about how to rein that [spending] in in a meaningful way and how to create sustainable solutions, but those are things I suspect.

Another priority for all of medicine is in physician reimbursement. We’ve seen over the last 20 years a decrease of 28% in physician reimbursement while there's been an increase in inflation and other things; it's created an issue of network inadequacy where some patients are not able to see doctors if they have Medicare as their primary payer. We don't want that for American seniors—we want them to be able to access good primary care, good specialty care. There has to be a doc fix that's discussed early on in order to in order to have a sustainable health care system.