Don’t Put Barriers between Patients and Care

Medicare is proposing to insert a middleman in the Part B drug supply chain. This would erect a barrier between patients and the personalized therapies that their physician prescribes to treat a serious chronic condition such as cancer, rheumatoid arthritis, macular degeneration, Crohn’s disease, or immunodeficiency diseases. These barriers take the form of restricting real-time decision making of physicians and techniques like strict prior authorization requirements and other formulary limitations.

Medicare has tried this before. In 2006 it launched the Competitive Acquisition Program (CAP) for Part B drugs (drugs that are infused and administered by a physician). Medicare chose a third-party drug vendor and physician practices could order drugs through the vendor. Medicare assured that CAP would relieve the administrative burden from physicians and result in lower prices. So why did Medicare shelve CAP in 2008, within 18 months of launching it? Because it placed a barrier between patients and the treatment physicians prescribed, increased drug costs and diverted resources from direct patient care.

The Association of Community Cancer Care has noted that the ’06 version of CAP saw delays getting drugs to the patient. Drugs were not available to treat patients, delaying personalized patient treatment plans crafted by physicians. Delays in treatment Medicare calculated that CAP resulted in increasing drug costs instead of decreasing them. In addition, rather than streamlining drug distribution, a middleman drug vendor created additional administrative hurdles. Medical practices had to invest in hiring additional staff to manage drug orders.

Medicare should learn from its previous missteps and not resurrect or repackage failed policies from the past.