Panelists Discuss Key Issues in Community Oncology Affecting Patients and Practices

A panel of providers discussed key advocacy issues that affect patients and practices and could improve access to care and costs during the 2018 Community Oncology Conference, hosted by the Community Oncology Alliance, April 12-13 in National Harbor, Maryland.

Debra Patt, MD, MPH, MBA, vice president of Texas Oncology, kicked off the session with an overview of some of the most important policy issues and trends affecting patients and specialists in the oncology space.

One of the top issues that is affecting care and exacerbating other challenges is the aging US population, she explained. As the population ages, more people are likely to develop cancer. So, even though there are more cancer diagnoses, this isn’t because oncologists are doing a bad job, said Patt. “We’re doing a really good job,” because more people are surviving their cancer and then living longer.

As the population ages, this presents challenges with cost, because more people who have cancer are enrolling in Medicare. The program must now pay for more expensive and innovative drugs to treat cancer. Patt highlighted that data show that there are projected to be 80 million Medicare beneficiaries in 2030, compared with 47 million in 2010.

She also highlighted the need for cancer drug pricing reforms, as the cost of cancer drugs continues to increase at a higher rate than US gross domestic product growth. “It’s an amazing time to be a cancer specialist,” she said, because of the innovations happening in treatment that have moved oncology from acute care to chronic care. But that innovation has translated to higher costs. “What we know is that that cost of care today is unsustainable.”

These higher costs, plus the combination of having more patients, means that the time is “ripe for drug pricing policy innovation.” Patt explained that she is expecting recommendations in the area to come from HHS, the Office of Management and Budget, legislation, and even an executive order with ongoing discussions about value-based pricing, indication-based pricing, and more.

Another area of concern for oncologists is the opioid epidemic and policies that restrict prescribing, which is important in cancer care.

“When I can’t cure cancer, palliation is the most important thing I can do,” Patt explained.

The challenge in oncology is that some policies restrict how many days’ worth of opioids a provider can prescribe, which presents an unfair situation for patients with cancer and chronic pain who may have to go to their doctor more often to get their pain medication.

Finally, Patt discussed the 340B program, which was created for hospitals treating a high share of poor patients, so they could purchase drugs at a discount to provide charity care. The problem is the lack of transparency around the program, such as how many poor people are being helped or what hospitals do with the money they save, such as if they use the money for executive compensation or if they use it to provide more services.

“340B was developed with very good intentions of helping patients who don’t have the means or patients who have a lot of co-pays and they can’t get treatment because of the cost of the treatment,” added Sibel Blau, MD, medical director at Northwest Medical Specialties.

However, the problem Blau highlighted was that in many cases, the hospital wants the community oncologist to send the patient to the hospital for full care, so the hospital can get the discounts in the 340B program. This can cause challenges for the patients who then have to travel far and often when they need treatment.

“Patients don’t realize they can get the care next door or 5 minutes away from home and the reason is [340B],” she said.

The lack of control and transparency in the 340B program means there are a lot of hospitals getting 340B pricing, it’s not only going to care for the poor or uninsured, but also going to patients with payers who don’t need the discounts, added Lucio Gordan, MD, medical oncologist and hematologist at Florida Cancer Specialists and Research Institute. This makes hospitals have more money and they start buying up small practices and specialty groups. As a result, the smaller practices “are choked” because referrals are all going to the hospital, which is an expensive setting to get care.

“The cost of oncology care and the cost of the setting, is easily 200%, sometimes 300% higher compared to an old-fashioned community oncology outpatient setting,” Gordan said.