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(May 23, 2002)

May 23, 2002

The Honorable George W. Bush
President of the United States
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500

Dear Mr. President:

The undersigned groups represent cancer patients, providers and researchers. As you know, the Nation's investment in cancer research is beginning to reap significant returns in reduced morbidity and mortality from cancer, a process that your Administration has supported through generous budget recommendations. While cancer research is thriving in many ways, there is great concern in the cancer community with respect to the infrastructure for delivering services for prevention, diagnosis and treatment of the disease.

Specifically, certain developments in reimbursement policy in the Medicare program threaten access of patients to quality cancer care. These include:

  • Since April 1, 2002, significant underpayment -- in many cases below cost -- for new drugs and biologicals administered in hospital outpatient departments;

  • Failure of the Medicare program to cover most oral anti-cancer drugs at a time when cancer drugs are increasingly available only in that form; and

  • Threatened shortfalls in overall reimbursement for administration of cancer chemotherapy in the office setting, based on proposed reductions in payment for chemotherapy drugs without simultaneous and meaningful reform of the significant underpayments for chemotherapy administered by a multidisciplinary cancer care team.

Viewing these developments, cancer patients could conclude that cancer care is significantly at risk for the Medicare population, which represents the majority of cancer diagnoses. Each of these unrelated reimbursement issues is uniquely important to the overall system of care in this country, and there are no reasonable or appropriate tradeoffs among them.

Thus, we strongly resist suggestions that expansion of Medicare coverage for oral anti-cancer drugs should be funded by an overall reduction in payments to physicians for chemotherapy. One is not a replacement for the other; instead, each of these elements is essential if patients are to have appropriate access to the lifesaving treatments that flow from our Nation's research investment.

Cancer is a complicated disease requiring multi-disciplinary approaches and access in a variety of geographical and institutional settings. Correspondingly, reimbursement for cancer care cannot be subject to severe reductions without consequences extending throughout the system of care.

While all in the cancer patient and provider community agree that reform of chemotherapy reimbursement is necessary, it is critical that such reform be undertaken in a way that will not undermine patient care and adversely affect health outcomes. The cancer patient community is particularly concerned that such momentous changes are being undertaken without the serious study that they require. Congress requested but never received a study by the General Accounting Office (GAO) that would answer the critical question of the actual cost of providing cancer care in these settings. In the absence of meaningful data from GAO, oncology professional societies are pursuing their own studies, though we have received indications that these are likely to be dismissed as non-objective. Some Members of Congress and many patient advocates believe that the task of developing the needed data should be assigned to the Institute of Medicine for a thorough and objective review. We would like to urge your careful consideration of this alternative. The risks for patients are too great to proceed in the absence of strong evidence on the issues in question.

As you have been thoughtful in your recommendations for research funding, we also would appreciate your careful deliberation in any efforts to revise or reform the current payment system for cancer care.

Cancer Leadership Council

American Cancer Society
American Society of Clinical Oncology
Cancer Care, Inc.
Cancer Research Foundation of America
The Children's Cause, Inc.
Coalition of National Cancer Cooperative Groups, Inc.
Colorectal Cancer Network
International Myeloma Foundation
Kidney Cancer Association
The Leukemia & Lymphoma Society
Lymphoma Research Foundation
Multiple Myeloma Research Foundation
National Coalition for Cancer Survivorship
National Patient Advocate Foundation
National Prostate Cancer Coalition
North American Brain Tumor Coalition
Oncology Nursing Society
Pancreatic Cancer Action Network
Susan G. Komen Breast Cancer Foundation
US TOO! International, Inc.
The Wellness Community
Y-ME National Breast Cancer Organization

cc: The Honorable Tommy Thompson, Secretary of HHS
Thomas Scully, Administrator, CMS
The Honorable Max Baucus
The Honorable Charles Grassley
The Honorable William Thomas
The Honorable Charles Rangel
The Honorable W.J. "Billy" Tauzin
The Honorable John Dingell

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