The Comment Letter Urges CMS to Improve Transparency and Ensure the Program Aligns with Original Intent of Helping Medicare Beneficiaries

WASHINGTON, D.C., UNITED STATES, May 30, 2024 /EINPresswire.com/ -- The Community Oncology Alliance (COA) has submitted comments encouraging the Centers for Medicare & Medicaid Services (CMS) to work with cancer care stakeholders to arrive at real, actionable solutions to improve Medicare Advantage (MA) and bolster access to quality, cost-effective cancer care. In its response to CMS’ Request for Information (RFI) on Medicare Advantage Data (CMS–4207—NC), COA offers a detailed analysis and recommendations around each of the questions posted in the RFI, including the need for CMS to increase transparency regarding prior authorizations (PAs) and denied claims; compliance with network adequacy; the accuracy and completeness of provider directories; the adequacy of Medicare Plan Finder; and the ability of Star Ratings to capture the experiences community oncology patients have with their providers and plans.

Click here to read COA’s full response to CMS’ Request for Information.

The letter details COA’s concerns over the MA program’s significant growth, which has led to MA plan sponsors becoming vertically integrated with pharmacy benefit managers (PBMs). This high level of vertical integration negatively impacts patients’ access to high-quality, cost-effective cancer care in their communities and decreases physician prescribing autonomy due to PA. As COA has noted in previous comments to CMS, it believes that PA practices by insurers in MA are out of control and serve as roadblocks that prevent cancer patients from getting the optimal treatment they require on a timely basis. To address this, CMS should consider expediting oncology treatment by implementing “gold card” programs, which could waive prior authorization requirements for treatments from certain providers who have high rates of historical PA approvals.

In the comments, COA also discusses the importance of empowering patients with cancer to make informed decisions about where they seek care. This requires CMS to provide publicly accessible analyses of MA network adequacy to provide patients with a better understanding of which providers are in-network. In the same vein, COA believes that provider directories play a crucial role in helping MA beneficiaries understand which providers are within their plan network, so it is critical that provider directories be up-to-date and easy to use. Another crucial tool for patients is the Medicare Plan Finder, which currently lacks functionality and makes it difficult for patients to compare plans. Lastly, COA states that the MA Star Ratings are a critical facet of MA that help beneficiaries choose the best plan for them, and therefore must expand to include negative experiences and additional measures.

It is critical that CMS, the Biden Administration, Congress, and cancer care stakeholders work together to improve MA through patient-centered policies that improve the quality, cost, access, and transparency among plans in the program.

To read COA’s full CMS MA RFI comment letter visit https://mycoa.communityoncology.org/education-publications/comment-letters/medicare-program-request-for-information-on-medicare-advantage-data.

About the Community Oncology Alliance

The Community Oncology Alliance (COA) is a non-profit organization dedicated to advocating for community oncology practices and, most importantly, the patients they serve. COA is the only organization dedicated solely to community oncology where the majority of Americans with cancer are treated. The mission of COA is to ensure that patients with cancer receive quality, affordable, and accessible cancer care in their own communities. More than 1.5 million people in the United States are diagnosed with cancer each year and deaths from the disease have been steadily declining due to earlier detection, diagnosis, and treatment. Learn more about COA at www.communityoncology.org.

Drew Lovejoy
Community Oncology Alliance
info@coacancer.org

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