How Congress Plans to Address Patient and Hospital Challenges, and How This Could Affect Oncologists

In a recent presentation, Barbara McAneny, MD, CEO of New Mexico Oncology Hematology Consultants and former AMA president; Nicolas Ferreyros, managing director at the Community Oncology Alliance (COA); and Frederick Schnell, MD, FACP, chief medical officer at the National Cancer Treatment Alliance and COA, discussed different challenges the US Congress encounters when new policies and legislation are updated. The panelists debated solutions for these challenges and how Congress should address these challenges for patients and hospitals moving forward. This panel was presented at the 2023 Clinical Pathways Congress with the Cancer Care Business Exchange.

A deep dive into pharmacy benefit manager (PBM) reform launched the discussion, where the panelists stressed that everything comes back to patients and hospitals both prioritizing the need to save money where they can. Dr McAneny, Dr Schnell, and Ferreyros agreed that the effect on prescription drugs from PBM reform would be modest at best. One of the challenges of immediate reform, such as PBM reform, is that bills often freeze up in the legislature and rapid reform becomes difficult to achieve, leaving many to wait for actual change to occur. Thus, to address the problem quickly, Congress needs to think of a different solution to lowering the cost of prescription drugs. Currently, congress is examining all the elements of PBM reform to address hospital and patient needs. “There’s 20 bills in Congress right now on PBMs, and the challenge in Washington . . . is going to be that they are going to get into a log jam and no one is going to really know what to do and they’ll freeze up. Maybe they will pass a small thing here, a small thing there, but they’re not really pushing to do a major reformation,” said Ferreyros.

The panelists explained that it is necessary for Congress to address these needs today for socioeconomically impacted groups. For example, how does a provider give proper care to someone who is homeless long-term and does not have the same access to finances as other patients? How do we ensure they get the care they need? The panelists agreed that Medicare coverage is necessary in ensuring access to care for those affected by economic hardships, and as a necessary part of a functioning society, Congress needs to invest in social safety nets for people to fall back on. Another of Congress’s main concerns today is understanding how physician fee schedule reimbursement impacts Medicare, as Medicare patients are about 25% underwater because of inflation.

Dr McAneny, Dr Schnell, and Ferreyros stressed that it is not enough for Congress to simply be aware of these issues—they need to take concrete steps to create real change and action. Everything comes down to it being an economic issue, and these economic needs need to be addressed in order to move forward with reform. “One of the main concerns in Congress is that the physician fee schedule is the only schedule that does not have an increase for inflation, cost of living increase, and has budget neutrality across government for anything that has increases in more than 20 million dollars,” said Dr McAneny. Patients will also not pay extra for drug costs if the cost is higher than what they will be reimbursed for. This does not mean that patients should have to pay more for drugs, however—it means the cost of drugs should be reasonable enough for all patients to afford. Another integral part of the solution is building safeguards to ensure patient quality of care.

Finally, the panelists recognized that there are those in Congress who are aware of these issues and want to solve them. Dr McAneny, Dr Schnell, and Ferreyros are hopeful for future policies and legislation to come, and look forward to the positive impact they can have for future patients and physicians.