Medicare Chemotherapy Payments: New Drug and Administration Fees Are Closer to Providers' Costs

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) required the Secretary of the Department of Health and Human Services to change the payment rates for chemotherapy-related drugs and chemotherapy administration services. These changes followed reports that Medicare payments for chemotherapy-related drugs were much higher than physicians' costs to acquire them, and oncologists' assertions that drug overpayments were needed to compensate for inadequate payments for chemotherapy administration services. In addition, the Centers for Medicare & Medicaid Services (CMS) made changes in billing rules for chemotherapy administration services. However, oncologists have been concerned that even with these changes, Medicare payments may not cover the costs of providing chemotherapy services in 2005. To respond to a Congressional request that we review the adequacy of Medicare payments for chemotherapy-related drugs and chemotherapy administration services in 2004 and 2005, we assessed the changes in these payments and compared the payments to the estimated costs of providing these services.