For state's seniors, lawmakers must continue Medicare Part B

October 25, 2012 

By Thomas Rado, Special to the Herald

Washington Insurance Commissioner Mike Kreidler recently made big promises about expanding health care in the state.

"In 2014, we're going to see 800,000 people in the state of Washington who do not have health insurance now covered -- and for tens of thousands of other people who do have health insurance they're going to have real health insurance for the first time," he said.

These goals are worthy. But to achieve appropriate access to health care for most Washingtonians, federal lawmakers must not make new cuts to Medicare that could negatively impact the access to medications that exists today for Washington seniors with serious illnesses under the Medicare Part B program.

In particular, federal lawmakers must carefully consider any proposed spending cuts to Medicare Part B drugs. Medicare Part B is the program that covers drugs purchased and administered by physicians, such as those that are injected into the bloodstream or otherwise involve detailed clinical knowledge and monitoring of the patient.

Part B covers treatments like chemotherapy, as well as treatments for multiple sclerosis and rheumatoid arthritis. About one out of every 10 people in Washington is enrolled in the program and may pay anywhere from $99 to $319.70 a month for their coverage, depending on their income.

Under Medicare Part B, the government directly reimburses physicians for the cost of drugs administered to patients. Payments are currently based on the average sales price of the drug plus an additional six percent that helps to cover overhead and other expenses related to acquiring and storing the drugs.

This reimbursement formula for Part B drugs has kept spending stable for these medicines and reduced beneficiary out-of-pocket costs.

A study by the Moran Co. found that even though total payments for drugs remained stable over the previous five years, medical inflation rose 21 percent over that period.

Studies also have shown that for many drugs, the difference between acquisition cost and the Medicare payment amount of average sales price plus 6 percent is slim.

However, in some cases doctors pay more to acquire the drugs than the reimbursement amount.

When doctors aren't properly compensated, there is a risk that they will stop seeing Part B patients, or worse, close their doors. This could result in the sick and elderly suffering from reduced access to vital treatments. A study by the Community Oncology Alliance has found that in the past four-and-a-half years, around 240 oncology clinics have closed and another 400 are struggling financially.

Unfortunately for Washington seniors, their doctors are facing tougher times ahead. As a result of deficit reduction legislation passed by Congress last year, all Medicare providers are facing across-the-board cuts to Medicare reimbursement rates in 2013, including Part B drugs, under a process known as sequestration.

However, things could get even worse. Last year, some in Congress had proposed to target Medicare Part B drug payments for cuts and Congress may well revisit that same legislative proposal before the year is over.

If Part B drug reimbursement rates are ratcheted down when clinics already are struggling, it could prove disastrous for Washington seniors. Lower Part B drug payments could contribute to the closure of already-struggling cancer treatment clinics. Patients would have fewer care options, potentially leading to longer wait times before they're treated or difficulty finding nearby treatment options.

We have to get Medicare spending under control, but well-intended Medicare cuts could have even bigger unintended consequences. We have to stop politicians in Washington, D.C., from haphazardly gutting Medicare Part B.

Here in Washington, we're lucky to have Sen. Maria Cantwell, who repeatedly has defended the program, including from cuts to Medicare Part B.

Residents of Washington need to reach out and let their representatives in Congress know that Medicare Part B must be protected from future cuts -- for the sake of patients and taxpayers.

w Dr. Thomas Rado is the owner and co-founder of Columbia Basin Hematology & Oncology at the Tri-Cities Cancer Center.

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