Polite Blase, Conti Rena M, Ward Jeffery C
From the Section of Hematology and Oncology, Department of Medicine, The University of Chicago, Chicago, IL; Departments of Pediatrics and Public Health Science, The University of Chicago, Chicago, IL; Department of Medical Oncology, Swedish Cancer Institute, Seattle, WA.
Am Soc Clin Oncol Educ Book. 2015:e75-80. doi: 10.14694/EdBook_AM.2015.35.e75.
Treating patients with cancer with infused or injected oncolytics is a core component of outpatient oncology practice. Currently, practices purchase drugs and then bill insurers, colloquially called "buy and bill." Reimbursement for these drugs is the largest source of gross revenue for oncology practices, and as the prices of cancer drugs have grown over time, these purchases have had significant impact on the financial health of practices and pose a risk that jeopardizes the ability of many practices to operate and provide patient care. Medicare Part B spending on drugs is under political scrutiny because of federal spending pressures, and the margin between buy and bill, lowered to 6% by the Medicare Modernization Act and further decreased to 4.3% by sequestration, is a convenient and popular target of budgetary discussions and proposals, scored to save billions of dollars over 10-year budget windows for each percentage-point reduction. Alternatives to the buy-and-bill system have been proposed to include invoice pricing, least costly alternative reimbursement, bundling of drugs into episode-of-care payments, shifting Part B drugs to the Medicare Part D benefit, and revision of the failed Competitive Acquisition Program. This article brings the perspectives of policy makers, health care economists, and providers together to discuss this major challenge in oncology payment reform.
使用注入或注射的溶瘤药物治疗癌症患者是门诊肿瘤学实践的核心组成部分。目前，医疗机构购买药物后向保险公司收费，通俗地称为“先买后付”。这些药物的报销是肿瘤学医疗机构总收入的最大来源，随着时间的推移，癌症药物价格不断上涨，这些采购对医疗机构的财务状况产生了重大影响，并构成了一种风险，危及许多医疗机构运营和提供患者护理的能力。由于联邦支出压力，医疗保险B部分的药品支出受到政治审查，“先买后付”的利润率，被《医疗保险现代化法案》降至6%，又因自动减支措施进一步降至4.3%，成为预算讨论和提案中一个方便且热门的目标，据估计，每降低一个百分点，在10年预算期内可节省数十亿美元。已有人提出“先买后付”系统的替代方案，包括发票定价、成本最低替代报销、将药物捆绑到护理期间支付、将B部分药物转移到医疗保险D部分福利，以及修订失败的竞争性采购计划。本文汇集了政策制定者、医疗保健经济学家和医疗服务提供者的观点，以讨论肿瘤学支付改革中的这一重大挑战。
