Medicare is pushing life-saving drugs out of physician offices — and older patients will suffer

Recent changes to Medicare drug pricing policy were enacted with a laudable goal: to lower costs for older adults. On a bipartisan basis, we share that goal. Medicare patients should have access to the treatments they need without facing unaffordable bills and bankruptcy. But as is often the case with complex legislation, there are unintended consequences that Congress must address quickly.

Without a targeted fix, a change to how Medicare reimburses certain physician-administered medicines could make it significantly harder for doctors to provide lifesaving therapies, especially for older people battling cancer and other complex diseases.

That’s why we introduced bipartisan legislation, the Protecting Patient Access to Cancer and Complex Therapies Act (H.R. 4299). This legislation would protect patient access to lifesaving treatments and hold physicians harmless, while saving the Medicare program $3.3 billion over 10 years.

This impact isn’t theoretical. Many of the most important therapies used to treat cancer, autoimmune diseases, neurological disorders and other serious conditions are administered directly in physicians’ offices or community clinics. These medicines often require specialized storage, careful handling and trained medical staff to administer safely. Administration in these offices, rather than in hospitals, is not only cheaper, but it is also much easier for patients.

Under Medicare Part B, physicians typically purchase these drugs themselves and are reimbursed by Medicare. For years, that reimbursement has been tied to the average sales price plus 6%, reflecting the real costs of administration and medication acquisition.

This system was designed to ensure that physicians can continue to provide treatments in community settings while keeping costs predictable for Medicare. However, recent changes tied to the new Medicare drug negotiation program unintentionally disrupt that balance.

Physician practices in every state could end up being reimbursed far less than they actually pay to acquire the drug in the first place. When that happens, practices are left with an impossible choice: absorb a significant financial loss or stop offering the treatment altogether.

Large hospital systems, through other means of cost shifting, may have the resources to weather that imbalance. But smaller physician practices, particularly in rural and underserved communities, simply do not.

Eastern North Carolina and California’s Central Valley may feel a world apart, but they are both areas with limited access to specialty care. It's in these communities where the consequences will be most significant. Independent oncology clinics and specialty practices could be forced to stop administering certain treatments. Patients would then have to travel long distances to hospital systems or face delays in lifesaving care.

That outcome would undermine the very goal of Medicare drug-pricing reform: protecting patients.

Our legislation provides a straightforward solution. It preserves the long-standing reimbursement structure tied to the average sales price so physicians can continue providing treatments in their practices. At the same time, it maintains key patient protections by ensuring coinsurance is still calculated based on the lower negotiated price.

Seniors still benefit from lower drug prices, but physicians are not placed in a position where providing the treatment becomes financially unsustainable.

Physicians and patient advocates across the country have already warned that failing to pass our bill puts community-based care at risk. Independent physician practices, especially in light of the 33% inflation-adjusted cuts to Medicare over the past 20 years, operate on extremely tight margins, and many are already navigating rising staffing costs, inflation and strangulating administrative burdens.

Policies that unintentionally push these practices out of the market could accelerate consolidation into large hospital systems, an outcome that significantly drives up costs for patients and Medicare. That’s not what Congress intended when it set out to reduce drug costs for seniors.

Our legislation ensures that the broader policy goals remain intact while preventing unintended disruptions to patient care.

In Washington, bipartisan cooperation can sometimes feel rare. But ensuring seniors can access the medicines they need should not be controversial.

By passing our bill now, Congress can ensure Medicare reforms deliver on their promise to lower costs for seniors without putting access to critical treatments at risk.

Congressman Greg Murphy, M.D., represents North Carolina's 3^rd Congressional District. He is a senior member of the House Ways and Means Committee and co-chair of the House GOP Doctors Caucus.

Congressman Adam Gray represents California’s 13th Congressional District, including Merced County and portions of Madera, Stanislaus, San Joaquin and Fresno counties. He is a member of the House Agriculture and Natural Resources Committees and is the Whip of the Blue Dog Coalition.