2018 U.S. Budget Agreement Contains Key Wins for ONS—Plus an Area of Concern

Key Win: Medicare Part B Drug Costs Excluded From MIPS

Consistent with ONS advocacy efforts, the law revises the Medicare Access and Children’s Health Insurance Program Reauthorization Act to exclude Medicare Part B drug costs from the Merit-based Incentive Payment System (MIPS) payment adjustments and eligibility calculations. This means that the drugs used in the treatment of cancer that are administered in the office setting will no longer be subject to significant shifts in reimbursement under MIPS or be considered when the agency is determining clinician eligibility under MIPS. This is a significant victory for the oncology and healthcare community.     

Key Win: $2 Billion Increase for NIH Research

As part of its strategic health policy agenda, ONS advocates for increased funding for National Institutes of Health (NIH) cancer and nursing research. The budget law included a bipartisan agreement to increase NIH funding by $2 billion over fiscal years 2018 and 2019 ($1 billion for each of the fiscal years), including funding at the National Cancer Institute and National Nursing Institute of Research. This is in addition to funding allocated from the 21st Century Cures Act for cancer research.

Key Win: Biosimilars Included in Medicare Part D Coverage Gap Discount Program

As reflected in a coalition letter that ONS signed and supported to reduce patient out-of-pocket drug costs, the budget law amends the Medicare Coverage Gap Discount Program to allow biosimilar manufacturers to pay the 50% discounts paid by their brand competitors. This change would reduce patient out-of-pocket costs and Part D program spending by an estimated $1 billion.

Key Win: IPAB Repealed

ONS is pleased that the budget law repeals the Independent Payment Advisory Board (IPAB). Created to keep Medicare entitlement spending under control, the IPAB required a board of nonelected government officials to recommend changes to the Medicare program when spending exceeded a targeted growth rate. If the board was not established or failed to make the prescribed cuts, the HHS secretary would have been given the power to make cuts to vital Medicare services without any input or oversight from Congress, regardless of the best interest of patients.

Key Win: CHIP Reauthorized Through 2027

ONS has advocated in support letters and Capitol Hill meetings for the reauthorization of the Children’s Health Insurance Program (CHIP) to ensure access to health care for children, including those with pediatric cancer. The budget measure reauthorizes and funds the CHIP program for 10 years, through 2027, which is the longest reauthorization of the program in its history.

Additional Provisions of Interest

ONS is pleased to see several measures in the budget law to improve care for the chronically ill, including those with cancer. The General Accounting Office (GAO) is to study having a Medicare payment code for the provision of a comprehensive plan of longitudinal care, including investigating the barriers to care planning for those with life-threatening illnesses, and would also assess the need for quality metrics for care planning. Another GAO study would identify how Medicare could improve synchronization of the multiple medications that patients with serious illnesses receive. ONS is also pleased with provisions to advance the availability of telehealth, including in Medicare Advantage.

Issue of Concern: CDC’s Prevention and Public Health Fund Cuts

ONS has concerns that major cuts were made to the Centers for Disease Control and Prevention’s (CDC’s) Prevention and Public Health Fund. Cancer prevention is a major tenet of the ONS Health Policy Agenda, and we want to make sure that CDC has the resources to continue these important programs.