Pricing, Payment Reform, and Politics Are Inextricably Linked in Cancer Care

To kick off the “Legislative Update From Capitol Hill: Cancer Politics & Policy in Washington, DC,” panel discussion on day 2 of the 2021 virtual Community Oncology Conference, moderator Ted Okon, MBA, executive director, Community Oncology Alliance, posed these questions: What is your perspective on how your organization sees and is dealing with the ongoing pandemic, and what have been some of your biggest challenges of the past year in community oncology?

Joining Okon on today’s panel were several industry experts:

• Christian G. Downs, JD, MBA, executive director, Association of Community Cancer Centers (ACCC)
• Ben Jones, vice president, Government Relations and Public Policy, The US Oncology Network
• Deborah Kamin, RN, PhD, vice president, Policy and Advocacy, American Society of Clinical Oncology
• Rebecca McGrath, vice president, Government Relations and Public Policy, Cardinal Health
• Brad Tallamy, senior director, Government Affairs, AmerisourceBergen

Downs responded first, in noting what ACCC has dealt with. “The first thing I'm looking at is the workforce. Oncology nurses have had to go on the road and become visiting nurses; there have been furloughs in support areas, like social work; and initiatives that kicked off in February 2020, for instance setting up new clinical services, have stalled,” he explained.

Most importantly, as several participants in other conference sessions have noted, “How are we going to operationalize this cohort of sicker patients that we're going to see? Because that's going to be a big challenge, I think, in a community setting,” he added.

“One of the biggest issues for us was reliable information,” Kamin stated. “Who are we going to listen to? What is the guidance for taking care of people who were midtreatment when all of this started?”

She, too, referred to the undoubtedly sicker patients who are beginning to emerge and for whom practices have to put together new infrastructure to handle. “It’s going to take a community effort to get there,” she emphasized.

For Jones, the biggest challenge continues to be the unknown. “The enormous amount of uncertainty is palpable,” he exclaimed. “We've seen a reduction in patient screenings that's led to a reduction in patient volumes. We've also got a tremendous amount of uncertainty in Washington, DC. We've been fighting for 6 years different iterations of Part B reforms dating back to 2015.”

In addition, he mentioned, there is continuing uncertainty surrounding 2 prominent payment reform models: the Radiation Oncology and the Oncology Care First models.

“The new administration is starting to transition from the midst of the crisis to the future, and being part of that is going to be really important,” McGrath stated, “both for lessons learned but also from the perspective of what does the future of community oncology look like, because because we're not going back to the way things were done before.”

AmerisourceBergen’s Tallamy highlighted the challenge, and great need, to ensure the long-term viability of community oncology practices. “At the outset of the pandemic, practices were already struggling with the 340B Drug Pricing Program, pharmacy benefits managers, consolidation. I worry about a postpandemic world in which we're going to be dealing with a stronger and smarter PBM [pharmacy benefit manager] stakeholder community.”

These concerns dovetailed into a passionate discourse on pricing reform, Paycheck Protection Program loans, provider relief, extending the pause on Medicare sequestration through the end of the year, and how politics ties in to it all.

“You have more partisan bickering than ever,” Tallamy bluntly stated, “and all of a sudden there’s talk of the infrastructure bill and paying for that. There’s always damage to community oncology.”

Underscoring the politics of it all, the panel agreed, are high levels of anxiety and uncertainty in a “highly polarized environment,” where everyone fears not being able to do their jobs because of proposed reforms or no longer being “the most efficient setting of care,” as Tallamy called it.

Another area of concern the experts agreed upon was the potential threat to the viability of community practices by reforms exacerbating the cost problem. “Drug pricing is not just a Democratic target,” Okon stated, with the panelists expressing what they believe will and won’t survive regarding drug pricing reform.

The steps that the panel thinks will be accomplished in drug pricing reform legislation ranged from putting in place inflationary caps on price increases across Medicare Parts B and D to out-of-pocket caps in Part D benefits design to investing in biosimilars to redesigning Medicare Part B altogether.

What did the panel think has a low probability of happening?

Direct and indirect remuneration, or DIR, fees, as well as responsive PBMs, McGrath contributed.

The bipartisan Prescription Drug Pricing Reduction Act of 2020, informally known as the Grassley-Wyden Bill, because “allowing the government to negotiate drug prices and international reference pricing, not only do you have strong Republican and industry opposition, you have some Democrat opposition to those politics, too,” Tallamy added.

People actually being able to understand what they’re voting on, according to Downs.

Pricing negotiation and international reference pricing, Kamin added.

The price negotiations that are based on foreign reference pricing, such as those “that would allow for a waiving of patent exclusivity if a manufacturer doesn’t play ball or a negotiated price that extends to the commercial market. I think some of those broader concepts are unlikely to be included,” Jones said.

“I wish we all had the magic answer,” Okon concluded. “I think it's going to be very hard to get through. Crazy things could happen.”