Cancer groups approach drug price overhaul with caution

Cancer groups are questioning if one of the policies in the Trump administration’s blueprint to tackle high drug prices is the right move to lower prices for patients.

The Trump administration wants to shift some drugs in Medicare Part B to Part D, saying the move would enable private vendors to negotiate with drugmakers to offer cheaper prices for Part B drugs, as they already do for drugs covered under Part D. Medicare Part B reimburses doctors for drugs administered in a doctor’s office, including vaccines and chemotherapy drugs. Medicare Part D is the prescription drug plan for Medicare enrollees.

The oncology practice association Community Oncology Alliance said a poll of 150 cancer doctors and rheumatologists found major concerns with the proposal. The American Cancer Society’s lobbying arm hasn’t taken a full position, but is skeptical of several parts of the plan outlined last week by the Trump administration.

The skepticism follows major criticism from the powerful pharmaceutical industry.

The Community Oncology Alliance, which represents oncology practices, was concerned about the shift because of the role in Medicare Part D of pharmacy benefit managers, which oversee drug plans for unions and employers. A PBM traditionally negotiates with a drug maker to get a rebate for a drug, but critics in the Trump administration warn that consumers aren’t seeing enough of the rebate because the PBM takes a cut.

Part D is “dominated by PBMs,” the alliance said.

Its survey of 150 doctors found 85 percent believe moving drugs from Part B to Part D will create “affordability issues for patients.”

The group has bashed PBMs for their secretive pricing practices, arguing that the companies keep too much of negotiated rebates and that they harm patient access to drugs through the use of specialty pharmacies.

The American Cancer Society’s advocacy arm, called the Cancer Action Network, has not taken a position on the proposed shift. But it does have a list of questions about how the program could be implemented and its impact, said Kirsten Sloan, the group’s vice president of public policy.

Chief among them, the society wants to know which drugs would be affected.

For instance, chemotherapy drugs are typically administered two ways: one is orally and another is intravenously, usually at an oncologist’s office. The society said it is easier for the oral drug to move to part D than the infusion drug.

It has logistical concerns, too, such as how a Part B drug is distributed.

“If you were getting a vaccine, that vaccine is given in your doctor’s office. If you are getting a chemo drug getting it in the doctor’s office,” Sloan said. “If we consolidate B and D, where does the beneficiary get their drug? Do they pick it up at CVS and take it to the doctor’s office?”

The Trump administration has put out a request for information for feedback on the proposal, which has received major pushback from the pharmaceutical industry.

The Pharmaceutical Research and Manufacturers of America, the drug industry’s leading lobbying group, said last week that changes to Part B could raise costs for seniors and limit access to treatments.

The administration has not said when it would release rules governing which drugs would be shifted to Part D and how. It also is exploring allowing third-party vendors to negotiate for lower prices for all drugs in Part B.

Health and Human Services Secretary Alex Azar has remained committed to the changes in a series of speeches since Trump’s Friday address on drug prices. Azar said Tuesday that drugs in Part B are covered by Medicare as soon as they are approved, whereas in Part D private plans determine whether a drug should be covered or if an alternative is superior.

“Moving away from the Part B system, often referred to as ‘buy and bill,’ is a positive step not only for the patient, but for the provider,” Azar said. “We don’t need doctors in the business of buying and selling expensive drugs — they should be able to make decisions based on what’s best for the patient.”

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