If you were hoping CMS would intervene to ease the effect of the 2% sequester cut on drugs, especially expensive cancer drugs, Marilyn Tavenner has all but killed that hope.
The CMS administrator, who recently became the first CMS head since 2005 to
earn confirmation from the Senate,
responded by letter to an inquiry from Rep. Pete Sessions, R.-Tex., about what Tavenner called “our authority for setting Part B drug payment rates as well as whether any flexibility exists in how we implement the sequester redactions,” reports the Huffington Post.
As
Part B News reported in April*, sequester cuts to Medicare have been especially brutal for “big-ticket drugs, especially those billed on a pass-through basis — that is, those with no mark-up allowed.” For many providers of such drugs – including cancer clinics – the cut has made their administration so expensive that it’s imperiling their practices.
Sessions had cited sequester-related memos from the Office of Management and Budget (OMB), including one that had instructed agencies to “
use any available flexibility to reduce operational risks and minimize impacts on the agency’s core mission in service of the American people” and “identify and address operational challenges that could potentially have a significant deleterious effect on the agency's mission or otherwise raise life, safety, or health concerns.”
After explaining CMS’ authority per Section 1847A of the Social Security Act and how ASP pricing works, Tavenner told Sessions that HHS had “assessed whether the law allows discretion to administer the sequestration reductions in a manner that is different from the across the board approach that has been used to implement it,” and as a result, “we do not believe that we have the authority under the Budget Control Act of 2011 to exempt Medicare payment for Part B drugs.”
Tavenner cited sections of the U.S. Code relating to
exempt programs and activities and
general and specific sequestration rules, and said the OMB memos “pertain to any flexibility regarding the agency's budgetary resources for internal operations such as the hiring of new employees,” which is “separate from the agency’s administration of Medicare payments, which are subject to the sequestration reductions, as noted above.”
It would now appear that the only way to end the cut would be to end the sequester.