The Medicare Prescription Drug Improvement and Modernization Act and the delivery of cancer chemotherapy.

PURPOSE

Pharmacists' increasing need for assistance in understanding the financial aspects of cancer treatment in physician office-based and hospital outpatient-based cancer programs, and the impact of changes in Medicare reimbursement rates associated with the Medicare Prescription Drug Improvement and Modernization Act (MMA) on providers of cancer chemotherapy and patients are discussed.

SUMMARY

Most cancer drugs are covered under Medicare Part B, although there is limited coverage under Part D. The financial burden on patients of paying for cancer chemotherapy has increased under both Part B and Part D. Changes in the basis for Medicare reimbursement for chemotherapy have reduced payment rates, and some currently available cancer drugs are reimbursed less than their actual cost. Pharmacy costs (i.e., overhead) were not accounted for in MMA, and quantifying these costs and finding a way to pay for them present challenges. Pharmacists need to be involved in discussions about Medicare spending and cost sharing by providers and patients.

CONCLUSION

Providing cancer chemotherapy presents patients and providers with unique financial challenges. Pharmacists have a stake in and need to provide input into Medicare decisions about reimbursement for cancer chemotherapy and cost sharing by patients and providers.