Biden-Harris Administration Issues Actions to Prevent Surprise Billing
In July 2021, the Biden-Harris administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury and the Office of Personnel Management, issued the Requirements Related to Surprise Billing. The rule applies to billing for patients in job-based and individual health plans who obtain emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.
ACA Provides Healthcare Coverage to 31 Million Americans
Approximately 31 million Americans now have healthcare coverage through the Affordable Care Act (ACA), according to a June 2021 issue brief from the office of the assistant secretary for planning and evaluation (ASPE). Of those, 11.3 million consumers were enrolled in Marketplace plans, 14.8 million people were newly enrolled in Medicaid, 1 million individuals were enrolled in ACA’s Basic Health Program option, and nearly 4 million previously eligible adults gained coverage under the Medicaid expansion due to enhanced outreach and increased federal funding. Additionally, insurance rates have fallen across the country since the law’s implementation 11 years ago.
Patient Advocate Groups Challenge Medicaid Engagement Requirements
The American Cancer Society, along with 14 other healthcare groups advocating for increased access to care, filed an amicus curiae—Latin for “friend of the court”—urging the U.S. Supreme Court to deny state imposition of engagement requirements, like monthly community service, for Medicaid beneficiaries. The U.S. Supreme Court is likely to spend spring deliberating and convey a judgment before the end of summer.
ACA Medicaid Expansion Improves Health and Increases Access to Care for Young Adults
The rate of uninsured young adults (aged 19–25) fell by more than one third between 2009 and the first quarter of 2014 following the Affordable Care Act’s (ACA’s) Medicaid expansion, according to a February 2021 report from the Urban Institute. With the expansion, young adults also reported improved overall health, increased access to care, and fewer high out-of-pocket costs.
WHO Campaigns for Global COVID-19 Vaccine Equity
More than 800 million COVID-19 coronavirus vaccine doses have been administered worldwide. However, 54% of those have been in high-income countries, which contain only 19% of the world’s population, whereas lower-middle income countries have only 33% of the vaccines for their 81% of the population. Those disparities have serious implications and limit equal access to health care, including vaccinations. The World Health Organization (WHO) is campaigning to address vaccine inequity on a global scale.
Biden’s American Rescue Plan Targets Social Determinants of Health and Other Disparities
The Biden administration’s American Rescue Plan (APR) is the largest, single piece of legislation focused on economics since Franklin D. Roosevelt proposed in his New Deal programs to pull the United States out of the Great Depression. Sweeping in scope, two of APR’s goals are to make health care accessible for all and to create formal plans for addressing racial disparities.
CMS Changes to Medicare Prescription Coverage Could Affect Patient Care
From Teddy Roosevelt to JFK, presidents throughout history have sent legislation to Capitol Hill with the intent to expand healthcare coverage to more Americans. Finally, when Lyndon B. Johnson drafted a bill and pushed it through Congress by expanding sections of the Social Security Act, Medicare become an entitlement and is now implemented by the Centers for Medicare and Medicaid Services (CMS). During the past 50 years, federal health coverage has grown to include Medicaid, maternal and childcare assistance, public health programs, and prescription medication pricing.
Billing and Coding Breakdown Helps Nurses Recognize the Realities of Reimbursement
Understanding correct coding strategies is an important skill that affects billing and reimbursement for value-based cancer care. Meeting the requirements for complete and accurate documentation is critical to support healthcare claims. Both nurses and advanced practice providers have responsibilities in this work.
Oncology Nurses Have a Responsibility to Manage the Financial Toxicities of Cancer
Cancer is one of the most expensive medical conditions to treat, and patients are expected to pay more and more out of pocket. Costs often lead to financial toxicity, defined as “distress or hardship arising from the financial burden of cancer treatment,” according to Darcy Burbage, DNP, RN, AOCN®, CBCN®, who discussed the topic in a session for the inaugural ONS Bridge™ virtual conference.
Mylan Patient Specialists Help Support Patients Through Biosimilar Cancer Treatments
Mylan understands that you care about your patients and that this may be a difficult time for them. Now more than ever, additional treatment options, such as biosimilars offerings may play an important role in providing patients access to medications they need.
President Trump Issues Executive Orders on Prescription Drug Pricing
In July 2020, U.S. President Donald Trump issued four executive orders to provide solutions to the ever-increasing price of prescription medications. One of the top domestic issues in healthcare is the price of prescription medication, particularly those deemed lifesaving, such as insulin for diabetics and drugs for patients with cancer.
Healthcare Worker Shortage; Trump Clashes With Big Pharma; Surprise Billing
Houston, TX, Miami, FL, and Baton Rouge, LA, are three of the many cities battling repercussions from the COVID-19 coronavirus pandemic. Most daunting is the perpetuated shortage of healthcare workers as the pandemic continues to ravage the United States.
Trump Uses Executive Orders to Lower Drug Pricing
As one of the only not-entirely-pandemic-related health policy topics currently in policymakers’ discussions, lawmakers are again revisiting the high cost of prescription drugs. Voters have voiced concerns in the current economic climate, and, eager to appease in the months before the November presidential election, the Trump administration responded.
Nurse-Turned-Policymaker; Prescription Drug Reform; Safer Working Conditions
As one of the youngest members of the 2018 freshman congressional class, U.S. Representative Lauren Underwood (D-IL) has already made quite a name for herself. Eschewing, for the most part in this heightened environment, partisanship and instead concentrating on health and economic issues, the representative champions access and affordability for all Americans.
CMS Grants Waivers to Providers During COVID-19 Public Health Emergency
In emergencies such as the COVID-19 coronavirus pandemic, government health agencies have the authority to grant waivers for various federal health programs. Starting on March 23, 2020, the Centers for Medicare and Medicaid Services (CMS) waived certain requirements and protocols for providers and beneficiaries.
Prescription Drug Proposal; COVID-19 Safety Legislation; Drug Costs Outpace Inflation
Drug pricing is a top legislative issue for Congress, and amid rising COVID-19 concerns, health policy topics are more pressing than ever. On March 5, Senator Martha McSally (R-AZ) introduced the Lowering Prescription Drug Prices for America’s Seniors and Families Act of 2020, which would allow Medicare to negotiate prices after a drug’s patent expires as well as cap out-of-pocket prescription spending for seniors at $3,100 per year.
How Oncology Nurses Can Support Patients During Financial Toxicity
As groundbreaking yet high-cost cancer treatments make their way into clinical practice, the effects of financial toxicity can put a damper on the profound effects that new, lifesaving medications can have on patients with cancer. It’s a problem that even Washington, DC, hasn’t been able to address—so what can oncology nurses do about it?
Congress Tackles Surprise Billing for Patient Access to Affordable Care
A patient is rushed to the emergency room, diagnosed, and taken to surgery immediately. The patient recovers, but weeks later a bill arrives beyond any expectation, and too often ability, to be paid. This practice has become so routine that it has its own name: balance billing or, more commonly, surprise medical billing. It strikes many Americans with the burden of their ailment once again.
HHS Announces Safe Importation Action Plan for High Medication Costs
The high cost of prescription medications—often lifesaving drugs—has become an unsustainable burden for many American patients. It’s a central topic in the healthcare conversation and a complex issue with countless moving parts. National opinion polling finds that a majority of people want to see changes in drug pricing.
The Battle Against Drug Pricing Wages On
Few know the power that prescription medications have on the quality of life for patients more than nurses. In more than just physical ways, access to affordable drugs is essential to patient-centered care and emotional, psychological, familial, and even financial stability. For too long, the cost and availability of medicines have been barriers to health care, rather than opportunities for survivorship.
Chapters Advocate for Patients and Nurses at Statewide Event in Annapolis
On March 26, 2019, more than 40 nurses came together at the Maryland General Assembly’s Senate President’s Conference Center for the Oncology Nurses Night in Annapolis. This was the Greater Baltimore Chapter of ONS’s (GBCONS’s) third advocacy trip to the statehouse, but it was the first statewide ONS event. All four Maryland chapters were active in planning the night, and many new advocates were inspired to speak out.
Healthcare Price Transparency; Cancer Survivor Caucus; Insurers Sue for ACA Backpay
Since 2016, then-candidate Trump promised he was going to bring healthcare costs under control. In a White House announcement on June 24, 2019, the president took steps to add transparency to the process by requiring insurance companies, hospitals, and physicians to identify fees and costs in public and simple ways for patients to see in advance and to understand.
As Drug Pricing Tops Capitol Hill Interest, ONS Advocates for Patient Access to Care
Reducing the high cost of prescription drugs continues to be a priority focus for both the U.S. Congress and Trump administration, and ONS is closely monitoring and providing input on how key proposals could affect patient access to oncology care.
$88 Billion for Health Care; Raising the Tobacco Age; 2020 Healthcare Push
According to a Gallup Poll released on April 2, 2019, Americans borrowed approximately $88 billion to pay for health care in 2018. At a National Academies of Science healthcare conference on April 4, the main takeaway was that many Americans surveyed reported that they could not afford to have a serious illness like cancer. The cost of care, even with insurance, is more than many can financially withstand. Oncology nurses know how patients must maneuver through the system to defer costs, sometimes resulting in delayed or alternative approaches to care.
Dems' Budget Fight; Pharma CEOs Face Congress; Patient Financial Struggles
Democrats control the majority of the House of Representatives, and it’s their responsibility to provide and pass a U.S. budget. As with any Congress, it’s always easier said than done. With a larger, more progressive freshman class interested in pushing more environmental, health, and welfare policy issues forward, costs will be a concern.
Experts Hold Conversations About Access and Affordability at ONS Policy Summit
Nurses should initiate financial conversations with patients early and offer resources to improve access to cancer care, speakers at the on November 13, 2018, concluded. The event, held at the Hyatt Regency Hotel on Capitol Hill in Washington, DC, brought together nurses and industry and government experts to address the issue of financial toxicity in today’s cancer care.
Proposed Medicare Payment Model Based on International Drug Prices Would Lower Patient Costs
On October 25, 2018, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar announced an advanced notice of proposed rulemaking (ANPRM) calling for a demonstration project to more closely align Medicare payment for certain Medicare Part B drugs and biologics with international prices, which an HHS analysis showed to be 1.8 times lower on average than in the United States. The proposal is a follow-up to the president’s prescription drug blueprint and HHS request for information to reduce patient out-of-pocket costs for prescription drugs. HHS estimates a savings of $17.2 billion over five years.
Dems on Health Care; Obamacare Enrollment; Pricey Precision Medicine
To Rally Voters, Democrats Focus on Health Care as Their Closing Argument
Although many states are already collecting early votes, Tuesday, November 6, 2018, will tell the full tale of the midterm elections. Many Democrats are emphasizing their focus on health care in the final days and hours before the election. By most measurable public opinion poll, health care remains the most important domestic issue for voters.
Unexpected Medical Costs; Senate Passes Opioid Bill; FDA E-Cigarette Regulation
The financial toxicity associated with cancer care is becoming a widely known side effect of cancer treatment. Beyond the disease's physical impact, patients are suffering from overwhelming medical costs, high prescription drug prices, and unforeseen, expensive complications. Those issues, often coupled with the inability to work, are leading to many patients quickly depleting their savings or slipping into debt.
HHS Drug Reform RFI Aims to Help Patients Better Afford Cancer Drugs
ONS shared the perspective of nurses caring for patients who may struggle to afford cancer drugs in comments submitted to the Department of Health and Human Services (HHS) on its Prescription Drug Reform Request for Information.
HHS Releases Blueprint for Affordable Prescription Drugs
Health care is arguably the top domestic policy issue and of major concern to most Americans. Coverage, access, and, most importantly, affordability are not abstract political concepts discussed in elite coffeehouse circles but rather are real-world problems that people struggle with daily. Do I need to see a physician for this problem? What impact will a diagnosis have on my life? Can I afford the medication?
APRNs Can Help Address Global Financial Toxicity
Advancements in oncology, such as new diagnostic tools and novel therapies, have improved overall survival rates but have come at a high cost. In 2011, targeted therapies accounted for 63% of all chemotherapy expenditures. A novel cancer drug routinely costs each patient more than $100,000 per year; annual spending on cancer drugs is globally estimated around $100 billion U.S. dollars and is predicted to rise to $150 billion by 2020.
Financial Toxicity Discussion Needs to Include Undocumented Patients
Financial toxicity in cancer care is an increasingly recognized burden for many patients. Driven by many factors, financial toxicity is often a combination of a patient’s individual characteristics, the costs associated with care, and the overall impact of the illness on a patient’s ability to work throughout the cancer journey. Financial toxicity negatively impacts patient outcomes, and many patients struggle with costs regardless of whether they’re covered by health insurance—this includes undocumented immigrants. Currently, more than 11.1 million undocumented immigrants live in the United States, and they aren’t immune to cancer diagnoses.
Federal Officials Say No to Lifetime Limits on Medicaid; Empowered Patients Are the Future of Health Care; Healthcare Jobs Continue to Grow Faster Than Jobs in the General Economy
On May 7, 2018, the White House told the Department of Health and Human Services to overturn Kansas’s new lifetime limit restrictions on Medicaid. Kansas has been leading the way for states looking to implement restrictions to federal benefits. The state previously implemented work requirements for Medicaid recipients and was trying to impose time limits for how long recipients could receive Medicaid for some time. Had its efforts stood, this would mark a fundamental shift in how the federal program is implemented at the state level.
President’s Cancer Panel Reports on Drug Costs and Value
Although it’s one of the less visible commissions, the President’s Cancer Panel monitors the activities of the National Cancer Program and reports on the burden of cancer. The panel reviews a number of topics and keeps current with demographic information and the latest cancer incidence research. After reviewing and recommending based on existing data, the panel releases a formal report to the president. In its most recent report, the panel found serious issues with barriers to access for cancer survivors, and it addressed the costs of drugs and the value therein.
New HHS Secretary Azar Aims to Tackle Drug Prices, Affordable Care
On January 24, 2018, the Senate officially confirmed the nomination of Alex Azar, the newest secretary of the Department of Health and Human Services (HHS). Azar replaces former HHS secretary Tom Price, a physician who stepped down in late 2017. Although confirmed along party lines, Azar’s long governmental experience had plenty of support despite his past connections to the pharmaceutical industry.
Patients’ Out-of-Pocket Cancer Costs Are Higher Than Expected
Despite having healthcare coverage, a third of patients with cancer end up paying more out of pocket than they expected for their cancer treatments, a new study found. The results were published in JAMA Oncology.
Why Do Oncology Nurses Need to Screen for Financial Toxicity?
It’s beneficial to think about financial toxicity in terms of issues adhering to treatment. Mounting evidence suggests that patients with financial toxicity aren’t adhering to their cancer care. It’s becoming a common side effect of cancer treatment, and patients might be less likely to take treatments their medical team prescribes because of it, leading to substandard care.
Financial Toxicity and Its Burden on Cancer Care
The cost of health care in the United States has been the source of debate for years. Questions range from the extent of Medicare and a Medicaid coverage, how—or if—the government should regulate drug prices, who deserves coverage, and how Institutions collect payments from insurance companies. But often, one important aspect is missing from the numerous conversations on health care, treatments, and financial reimbursements: the patients.
Local Organizations Can Make a Big Difference in Cancer Care
I have the privilege of managing and being the sole provider in a unique program. I work in the Hereditary Cancer Program at Saint Louis University Cancer Center, where I provide risk assessment services and education about genetic testing to individuals and families in the region. It’s an amazing nursing role, and I can truly help people prevent cancer and manage their risk.
What Rising Cancer Costs Are Doing to Patient Well-Being
The cost of cancer has increased substantially over the years and is continuing to trend upward. During a session at the Oncology Nurse Advisor Navigation Summit, Yousuf Zafar, MD, MHS, an associate professor of medicine and public policy at Duke Cancer Institute, gave some facts and figures on cancer costs and how these are impacting patient well-being.
Program Improves Care and Decreases Costs for Patients With Cancer
The estimated cancer prevalence by age in the United States is expected to increase from 216 million in 1975 to 380 million in 2040. With older cancer survivors, the severity of disease and treatment will increase, and the physiologic effects of aging, such as pre-existing conditions and new-onset morbidity, will impact the level of care needed for older adults.
Bipartisan Cancer Parity Drug Legislation Introduced in U.S. Congress
Two members of the House of Representatives have put political party differences aside and introduced bipartisan legislation that requires health insurers to cover traditional chemotherapy, along with oral medications associated with cancer treatment. U.S. Representatives Leonard Lance (R-NJ) and Brian Higgins (D-NY) have proposed the Cancer Drug Parity Act (H.R. 1409). The intent of the bill is to ensure appropriate oncologic treatments are affordable and covered for patients with cancer.
Help Your Patients Find Financial Resources
The financial burden associated with cancer treatment is reaching new heights. In the heat of making decisions, patients and their families may drastically deplete their finances to reap the advantage a new drug may offer.