Legislative Updates

MSCO joined Massachusetts ACS CAN and other state organizations in letters of support, for the following federal bill, that were sent to all Massachusetts state congress members. H.R. 2407: the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act 

We requested that all members of the Massachusetts delegation support this most important bill. The early detection of cancer gives patients the greatest hope of beating the disease. This legislation recognizes the extraordinary unmet need in early detection of many different types of cancer, and will modernize Medicare, allowing the agency to determine coverage of multi-cancer early detection tests once FDA approved and when clinical benefit is shown, resulting in further reducing suffering and death from cancer for everyone.

The Massachusetts Society of Clinical Oncologists (MSCO) and the Association for Clinical Oncology (ASCO) are pleased to submit a letter of support of H. 982, a bill that would protect Massachusetts patients from non-medical switching of medications. MSCO and ASCO are encouraged by the steps that H. 982 takes toward improving continuity of care and preventing non-medical switching in Massachusetts. We urged the committee to vote for passage on this measure.

The Massachusetts Society of Clinical Oncologists (MSCO) and the Association for Clinical Oncology (ASCO) are pleased to support H. 953 / S. 609, companion bills which would take steps to protect patients with cancer in Massachusetts from copay accumulator programs. MSCO and ASCO are encouraged by the steps H. 953 / S. 609 take toward eliminating co-pay accumulator programs in Massachusetts, and we strongly urge the committee to pass the measure.

Testimony was submitted on behalf of the Massachusetts Society of Clinical Oncologists (MSCO). MSCO supports H.1074 and S.689, which would expand access to biomarker testing in the Commonwealth by requiring health insurers to cover such testing that meet nationally recognized criteria for such testing. MSCO believes that adequate insurance coverage for patients battling cancer, including needed biomarker testing, is needed to enable patients and their families to have access to the benefits of advanced cancer research and treatment.

In response to advocacy from the American Medical Association and organized medicine about the ongoing impacts of the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) will continueto allow physicians and group practices to apply for a MIPS Extreme and Uncontrollable Circumstances hardship exception to avoid up to a -9% MIPS penalty in 2025 based on 2023 performance. The exception will not be automatic, and interested physicians and groups must actively request reweighting of one or more MIPS performance categories due to the COVID-19 PHE. Requesting reweighting of all four MIPS performance categories will avoid a MIPS penalty in 2025. CMS expects to release the hardship exception application in spring 2023.

This is a big relief for physicians and their patients because CMS estimated in the final rule that up to one-third of MIPS eligible clinicians would have received a penalty due to the increasingly stringent requirements to participate in MIPS in 2023. It is also likely that small, rural, and practices serving underserved populations would have been disproportionately impacted by these penalties. We encourage you to spread the word to your members about this critical reprieve from up to a -9% penalty due to the COVID-19 PHE.

On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Medicare Advantage and Part D Final Rule, which will revise regulations governing Medicare Advantage (MA), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). The rule makes changes related to prior authorization, health equity, marketing and communications, and other areas on which Association for Clinical Oncology (ASCO) commented during the rulemaking process.

In response to advocacy from the American Medical Association and organized medicine about the ongoing impacts of the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) will continue to allow physicians and group practices to apply for a MIPS Extreme and Uncontrollable Circumstances hardship exception to avoid up to a -9% MIPS penalty in 2025 based on 2023 performance. The exception will not be automatic, and interested physicians and groups must actively request reweighting of one or more MIPS performance categories due to the COVID-19 PHE. Requesting reweighting of all four MIPS performance categories will avoid a MIPS penalty in 2025. CMS expects to release the hardship exception application in spring 2023.

This is a big relief for physicians and their patients because CMS estimated in the final rule that up to one-third of MIPS eligible clinicians would have received a penalty due to the increasingly stringent requirements to participate in MIPS in 2023. It is also likely that small, rural, and practices serving underserved populations would have been disproportionately impacted by these penalties. We encourage you to spread the word to your members about this critical reprieve from up to a -9% penalty due to the COVID-19 PHE. 

The Association for Clinical Oncology (ASCO) submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) Contract Year 2024 Policy and Technical Changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit Programs proposed rule. ASCO’s comments focus heavily on the proposed changes to prior authorization in the MA program in addition to enhancing health equity and other updates to the Part D drug benefit program.

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Both chambers of the United States Congress are working on a top health care priority for the session—protecting patients from high out-of-pocket drug costs and pharmacy benefit manager (PBM) practices that could reduce access and adherence to treatments.

In the Senate, Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA) recently introduced the Pharmacy Benefit Manager Transparency Act of 2023 (S.127), legislation that would incentivize fair and transparent PBM practices, prohibit unfair or deceptive pricing practices, and mandate transparency. The Association for Clinical Oncology (ASCO) endorses this timely legislation and will continue to work with bill sponsors to shed light on opaque PBM practices that can negatively impact individuals with cancer.

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On January 30, 2023, President Biden announced the COVID-19 Public Health Emergency (PHE) will end on May 11, 2023. This announcement comes after the Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the PHE earlier in January.

During the PHE, the Centers for Medicare & Medicaid Services (CMS) temporarily approved several telehealth flexibilities. The Omnibus that passed at the end of 2022 extended these telehealth flexibilities for two years; they are set to expire December 31, 2024.

While the Association for Clinical Oncology has been advocating for permanent extension of telehealth flexibilities, the two-year extension allows Congress time to study how telehealth is being used, create parameters to avoid abuse, and identify a way to pay for the permanent expansion.