The new Medicare Bill (MMA) still has major flaws, in that it continues to provide incentives to administer chemotherapy, in the same way that surgeons have a financial incentive to recommend surgery. Additionally, it is a certainty that there will be large differences between the profit margins of administering different drugs, providing continuing incentives to base drug selection on profit margin. However, the new system is clearly an improvement from the standpoint of cancer patients, taxpayers, and advocates of basing drug selection on individual tumor biology, rather than on a least common denominator approach which invites "conflict-of-interest medical decision-making."
What this shows is that simply reducing reimbursement for drugs isn't the answer to the biggest problems, which are financial incentives for infusion therapy over oral therapy or non-chemotherapy, and financial incentives for choosing some drugs over others. One example, oncologists will just not give gemcitabine and /or irinotecan, but instead will choose drugs which are profitable.
Oncologists should simply submit copies of their drug invoices and get paid the exact cost of the drugs, plus a small markup for administrative expenses. They should get reimbursed for the costs of actually adminsitering the drugs, plus a small markup which is not enough of an incentive to treat with infusion therapy, rather than just writing a prescription for drugs which would be filled at a pharmacy.
Under the new Medicare Bill (MMA) medical oncologists will be reimbursed for providing evaluation and management services, making referrals for diagnostic testing, radiation therapy, surgery and other procedures as necessary, and offer any other support needed to reduce patient morbidity and extend patient survival.
Because oral-dose drugs ultimately deliver on their promise of combining equally efficacious therapy with better adverse event profiles and easier administration, they will rightfully gain their appropriate share of the marketplace, again.
What needs to be done is to remove the profit incentive from the choice of cancer treatments. Patients should receive what is best for them and not what is best for their oncologists.