publication date: Nov. 21, 2014

ASCO Proposes Principles for Debate on the Future of Medicaid Programs

The American Society of Clinical Oncology has proposed a set of principles for shaping future debate of the role of Medicaid.

The principles set forth in a paper published in the Nov. 17 issue of the Journal of Clinical Oncology are:

• No individual diagnosed with cancer should be without health insurance that guarantees access to high-quality cancer care delivered by a cancer specialist.

• Patients with cancer who have Medicaid should receive the same timely and high-quality cancer care as patients with private insurance.

• Medicaid payments should be sufficient to ensure that Medicaid patients can have access to quality cancer care.

• Patients with cancer who have Medicaid should not face insurance barriers to clinical trial participation.

ASCO said it regards Medicaid reform as one of its top priorities.

“Every patient should be able to receive high-quality cancer care, regardless of his or her financial circumstances,” ASCO President Peter Paul Yu said in a statement. “Millions of Americans who rely on Medicaid won’t be able to take advantage of advances in cancer prevention and treatment unless meaningful reform occurs.”

Altogether, 67.9 million Americans—about one in five—are enrolled in Medicaid. Cancer patients and cancer survivors account for about 2.1 million Medicaid recipients, according to ASCO.

Studies show that Medicaid patients often do not receive the same quality of cancer care as patients with private insurance, and they are up to three times more likely to be diagnosed with cancer at a late stage, when treatment is less likely to be effective, the society said.

ASCO’s policy recommendations follow:

1. Expand insurance coverage for individuals below the federal poverty level.

2. Ensure oral parity for patients with Medicaid coverage and include oral and intravenous cancer therapies, as well as supportive care medications, as exempt services for cost-sharing purposes (similar to preventative services, services provided to hospice patients, and so on).

3. Extend clinical trial protections included in the ACA to patients with Medicaid coverage, and allow patients with Medicaid coverage to cross state lines to participate in those trials.

4. Eliminate artificial barriers between current Medicaid beneficiaries and newly eligible beneficiaries, and apply ACA final-rule mandates for cancer screening and diagnostic follow-up without copay for all Medicaid beneficiaries.

5. Require coverage for genetic testing, without deductibles or copays, in any patient deemed at high risk for an inheritable cancer risk syndrome as defined by published guidelines.

6. Improve the 340B Drug Pricing Program so that it is used for its original intent: to incentivize care for the uninsured and underinsured and patients with Medicaid coverage, regardless of care setting.

7. Eliminate variation between Medicare and Medicaid physician payment rates for cancer diagnosis and treatment by raising Medicaid payments to Medicare rates.

8. Tie state flexibility in running Medicaid programs to the requirement to meet predefined cancer quality metrics.

9. Allow oncology practices to be designated as medical homes, and develop expanded reimbursement for care coordination and patient education for oncology practices.

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