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Case
Study Improving
Medicare's Coverage for Cancer Treatments Situation:
Medicare's reimbursement rules were creating incentives for physicians to provide off-label
cancer treatments to patients in hospitals rather than in outpatient clinics.
Oral forms of anti-cancer medicines were not covered by Medicare even though
the same chemical compounds were covered when given to patients via an
injection or an infusion.
Actions:
Wrote legislative language to require Medicare to pay for:
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Off-label
uses of treatments for cancer in outpatient clinical setting |
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The
oral forms of anti-cancer medicines that were already covered
when
administered to patients by physicians as an injection or an
infusion |
Oversaw
economic analyses showing cost neutrality of proposals.
Created integrated messages that coupled economic analyses with an explanation
of how the legislation would improve the quality of healthcare
for patients with cancer:
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Outpatient
care is less likely to result in hospital acquired
infections,
and is a less costly setting for providing the same treatments
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Oral
forms of medicines are less likely to cause systemic
side-effects
and don't require the staff, equipment, costs or patient
discomfort of IV
administration |
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Created
messages about how the proposal would increase the
incentives for developing more oral forms of treatments for cancer
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Worked with Congressional staff to refine and support the proposals.
Developed relationships with cancer patient advocacy groups and educated
them
about the value of the proposals, and worked with their representatives and other
allies to support the proposals.
Researched,
developed and implemented legislative
strategy characterized by a Congressional staffer as a “miracle," which enabled passage of the proposals.
Outcome:
Both
proposals were signed into law. These improved the quality of care for
Medicare patients with cancer by removing disincentives for treating Medicare
cancer patients as outpatients, and by increased incentives for the
development of more oral forms of anti-cancer medicines.
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